In intensive care, suppression of the immune system and inflammation are common situations requiring frequent and heavy pharmacological interventions with, among others, antibiotics, vasodilators and opioids.

The impact on the intestinal microbiome is predictable and confirmed, leading to marked dysbiosis with a consequent increased risk of hospital infections, sepsis or multi-organ dysfunction.

Patients in these wards generally have a decrease in good commensal bacteria (Firmicutes and Bacteroidetes) with, on the other hand, an increase in pathogenic ones such as Proteobacteria. Although dysbiosis is clear, its more precise characterization is more complicated due to high intra- and inter-patient heterogeneity.

However, analysis of the microbiota by enterotype has shown recent advantages. In humans, three enterotypes have been identified based on the predominance of Bacteroides (E1), Prevotella (E2) or Ruminococcus (E3) independent of diet, genetics and environmental exposure.

More attention should therefore be paid to the gut microbiota in the treatment of critically ill patients.

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