Published online Oct 7, 2015. doi: 10.3748/wjg.v21.i37.10487
Peer-review started: January 30, 2015
First decision: April 14, 2015
Revised: April 28, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: October 7, 2015
Processing time: 242 Days and 4.4 Hours
The intestinal microbiome is emerging as a crucial mediator between external insults and systemic infections. New research suggests that our intestinal microorganisms contribute to critical illness and the development of non-gastrointestinal infectious diseases. Common pathways include a loss of fecal intestinal bacterial diversity and a disproportionate increase in toxogenic bacterial species. Therapeutic interventions targeting the microbiome - primarily probiotics - have yielded limited results to date. However, knowledge in this area is rapidly expanding and microbiome-based therapy such as short-chain fatty acids may eventually become a standard strategy for preventing systemic infections in the context of critical illness.
Core tip: The role of the intestinal microbiome in the development and treatment of Clostridium difficile (C. difficile) infection is well established. However, the intestinal microbiome is emerging as a crucial mediator in the development of systemic disease and non-gastrointestinal infection. If the pathways linking gut bacteria to systemic infections can be elucidated, it may become possible to intervene upon the microbiome before disease occurs. This understanding would move clinicians beyond fecal microbial transplant for C. difficile infection to paradigm-changing treatments for gut-derived systemic infections.