title: The gut microbiome and the mechanism of surgical infection.
abstract: BACKGROUND
  Since the very early days of surgical practice, surgeons have recognized the importance of considering that intestinal microbes might have a profound influence on recovery from surgical diseases such as appendicitis and peritonitis. Although the pathogenesis of surgical diseases such as cholelithiasis, diverticulosis, peptic ulcer disease and cancer have been viewed as disorders of host biology, they are emerging as diseases highly influenced by their surrounding microbiota.
  
  
  METHODS
  This is a review of evolving concepts in microbiome sciences across a variety of surgical diseases and disorders, with a focus on disease aetiology and treatment options.
  
  
  RESULTS
  The discovery that peptic ulcer disease and, in some instances, gastric cancer can now be considered as infectious diseases means that to advance surgical practice humans need to be viewed as superorganisms, consisting of both host and microbial genes. Applying this line of reasoning to the ever-ageing population of patients demands a more complete understanding of the effects of modern-day stressors on both the host metabolome and microbiome.
  
  
  CONCLUSIONS
  Despite major advances in perioperative care, surgeons today are witnessing rising infection-related complications following elective surgery. Many of these infections are caused by resistant and virulent micro-organisms that have emerged as a result of human progress, including global travel, antibiotic exposure, crowded urban conditions, and the application of invasive and prolonged medical and surgical treatment. A more complete understanding of the role of the microbiome in surgical disease is warranted to inform the path forward for prevention.
authors.affiliation: Department of Surgery and Laboratory of Surgical Infection Research and Therapeutics, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Alverdy
authors.affiliation: Department of Surgery and Laboratory of Surgical Infection Research and Therapeutics, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Hyoju
authors.affiliation: Department of Surgery, Radboud University, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Weigerinck
authors.affiliation: Department of Surgery and Laboratory of Surgical Infection Research and Therapeutics, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Gilbert
mesh_terms: D056704:Adaptive Immunity; D057868:Anastomotic Leak / Q000382:microbiology; D000069196:Gastrointestinal Microbiome; D006801:Humans; D045823:Ileus / Q000382:microbiology; D007113:Immunity, Innate; D009747:Nutritional Physiological Phenomena; D018805:Sepsis / Q000382:microbiology; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000517:prevention & control*; D014945:Wound Healing