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World J Gastroenterol. Dec 14, 2026; 32(46): 123234
Published online Dec 14, 2026. doi: 10.3748/wjg.123234
Published online Dec 14, 2026. doi: 10.3748/wjg.123234
Antibiotic-associated gut dysbiosis and intestinal failure in critically ill patients: Mechanisms and interventions
Liang Tian, Shan-Shan Xu, Department of Pharmacy, Shanghai Deji Hospital, Qingdao University Shanghai Clinical Medical College, Shanghai 200331, China
Author contributions: Tian L and Xu SS conceived and designed the study, analyzed the data and wrote the manuscript; Xu SS performed the systematic literature search and data extraction; Tian L supervised the study and critically revised the manuscript; and all authors have read and approved the final manuscript.
AI contribution statement: AI tools (specifically Claude, Anthropic, version claude-sonnet-4-6) were used solely for linguistic refinement, structural organization assistance, and formatting of the manuscript. No AI tool was involved in the generation of research data, interpretation of results, formulation of scientific conclusions, design of figures, or selection of references. All AI-generated outputs, including language suggestions and text organization, were critically reviewed, substantively revised, and verified for accuracy by the authors. The authors take full responsibility for the accuracy, originality, and integrity of the final manuscript in accordance with ICMJE and COPE guidelines.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Liang Tian, MD, Associate Faculty, Chief Pharmacist, Department of Pharmacy, Shanghai Deji Hospital, Qingdao University Shanghai Clinical Medical College, No. 378 Gulang Road, Putuo District, Shanghai 200331, China. tianliang@shneuro.org
Received: May 13, 2026
Revised: June 30, 2026
Accepted: July 28, 2026
Published online: December 14, 2026
Processing time: 161 Days and 12.7 Hours
Revised: June 30, 2026
Accepted: July 28, 2026
Published online: December 14, 2026
Processing time: 161 Days and 12.7 Hours
Core Tip
Core Tip: Broad-spectrum antibiotics precipitate a four-stage pathological cascade in critically ill patients: Gut microbiota dysbiosis, short-chain fatty acid depletion, intestinal barrier injury, and systemic inflammatory activation, ultimately driving multiple organ dysfunction syndrome. This review maps each cascade stage to a specific intervention, proposing a stage-based therapeutic framework. Three clinical priorities: Microbiome surveillance after prolonged antibiotic exposure, early enteral nutrition within 48 hours, and integration of days-of-therapy/antibiotic spectrum index metrics into stewardship decisions.