title: Microbiota-targeted therapies on the intensive care unit.
abstract: OBJECTIVE
  The composition and diversity of the microbiota of the human gut, skin, and several other sites is severely deranged in critically ill patients on the ICU, and it is likely that these disruptions can negatively affect outcome. We here review new and ongoing studies that investigate the use of microbiota-targeted therapeutics in the ICU, and provide recommendations for future research.
  
  
  RESULTS
  Practically every intervention in the ICU as well as the physiological effects of critical illness itself can have a profound impact on the gut microbiota. Therapeutic modulation of the microbiota, aimed at restoring the balance between 'pathogenic' and 'health-promoting' microbes is therefore of significant interest. Probiotics have shown to be effective in the treatment of ventilator-associated pneumonia, and the first fecal microbiota transplantations have recently been safely and successfully performed in the ICU. However, all-encompassing data in this vulnerable patient group remain sparse, and only a handful of novel studies that study microbiota-targeted therapies in the ICU are currently ongoing.
  
  
  CONCLUSIONS
  Enormous strides have been made in characterizing the gut microbiome of critically ill patients in the ICU, and an increasing amount of preclinical data reveals the huge potential of microbiota-targeted therapies. Further understanding of the causes and consequences of dysbiosis on ICU-related outcomes are warranted to push the field forward.
authors.affiliation: aCenter for Experimental and Molecular Medicine bDepartment of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands cUniversity College London Hospitals, London, UK.
authors.forename: Bastiaan W
authors.initials: BW
authors.lastname: Haak
authors.forename: Marcel
authors.initials: M
authors.lastname: Levi
authors.forename: W Joost
authors.initials: WJ
authors.lastname: Wiersinga
mesh_terms: D064806:Dysbiosis; D006801:Humans; D007362:Intensive Care Units; D064307:Microbiota; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000628:therapy*; D019936:Probiotics / Q000627:therapeutic use*