Neag Maria Adriana, Mitre Andrei Otto, Pomana Irina Georgiana, Velescu Maria Amalia, Militaru Claudia, Nagy Georgiana, Melincovici Carmen Stanca
Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
Department of Morpho-Functional Sciences, Discipline of Pathophysiology, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Diseases. 2025 Aug 7;13(8):250. doi: 10.3390/diseases13080250.
Critical illness profoundly disrupts the gut microbiota leading to a state of dysbiosis characterized by reduced microbial diversity and overrepresentation of pathogenic taxa such as Enterobacteriaceae and Proteobacteria. This dysbiotic shift compromises gut barrier integrity and modulates immune responses, contributing to systemic inflammation and increasing susceptibility to nosocomial infections and multi-organ dysfunction. Nutritional strategies in the ICU significantly influence the composition and function of the gut microbiota. Enteral nutrition supports the maintenance of microbial diversity and gut mucosal health, whereas parenteral nutrition is associated with mucosal atrophy and further microbial imbalance. Emerging interventions, including the administration of probiotics, prebiotics, synbiotics, and fermented products like kefir, show promise in restoring microbial equilibrium and improving patient outcomes. This review presents current evidence on the alterations of the gut microbiota in critically ill patients, explores the systemic consequences of dysbiosis, and evaluates the impact of nutritional and microbiota-targeted therapies in improving patient outcomes.
危重病会严重破坏肠道微生物群，导致生态失调状态，其特征是微生物多样性降低，以及肠杆菌科和变形菌等致病菌群过度繁殖。这种生态失调转变会损害肠道屏障完整性并调节免疫反应，导致全身炎症，并增加医院感染和多器官功能障碍的易感性。重症监护病房（ICU）的营养策略会显著影响肠道微生物群的组成和功能。肠内营养有助于维持微生物多样性和肠道黏膜健康，而肠外营养则与黏膜萎缩和进一步微生物失衡有关。包括施用益生菌、益生元、合生元以及开菲尔等发酵产品在内的新干预措施，在恢复微生物平衡和改善患者预后方面显示出前景。本综述介绍了危重病患者肠道微生物群改变的当前证据，探讨了生态失调的全身后果，并评估了营养疗法和针对微生物群的疗法对改善患者预后的影响。
