aCenter for Experimental and Molecular Medicine bDepartment of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands cUniversity College London Hospitals, London, UK.
Curr Opin Crit Care. 2017 Apr;23(2):167-174. doi: 10.1097/MCC.0000000000000389.
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.
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.
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.
危重症患者 ICU 中，其肠道、皮肤和其他几个部位的微生物群落组成和多样性严重失调，这些紊乱很可能对预后产生负面影响。本文综述了目前正在研究的针对 ICU 中肠道菌群靶向治疗的新研究，并为未来的研究提供了建议。
ICU 中的几乎每一种干预措施以及危重病本身的生理效应都可能对肠道微生物群产生深远的影响。因此，靶向调节微生物群，旨在恢复“致病”和“促进健康”微生物之间的平衡，具有重要意义。益生菌已被证明可有效治疗呼吸机相关性肺炎，最近在 ICU 中安全且成功地进行了首次粪便微生物移植。然而，在这个脆弱的患者群体中，全面的数据仍然很少，目前只有少数几项正在 ICU 中研究肠道菌群靶向治疗的新研究。
在 ICU 危重病患者的肠道微生物组学方面已经取得了巨大的进展，越来越多的临床前数据揭示了肠道菌群靶向治疗的巨大潜力。进一步了解 ICU 相关结果中肠道菌群失调的原因和后果，将有助于推动该领域的发展。
