The Emerging Role of the Microbiota in the ICU

Nora Suzanne Wolff; Floor Hugenholtz; Willem Joost Wiersinga


Crit Care. 2018;22(78) 

In This Article

The Road Ahead

Hospital-acquired infections are a huge problem in patients on the ICU. Antibiotic administration is the usual form of treatment or prevention of these infections and is lifesaving. However, as a side-effect, it severely affects the microbiota, risks induction of antibiotic resistant pathogens and potentially even the new onset of severe infection. Restoring the microbiota after antibiotic treatment has the potential to reduce infections.[10,23] Different approaches can be utilized: probiotics, prebiotics (a dietary ingredient that promotes beneficial microbiota) and synbiotics (a combination of a probiotic with a prebiotic) have all been tested in various patient groups on the ICU with mixed results.[4,49] Probiotics will not reestablish a complete microbiota. This can be achieved to a larger extent by performing a fecal microbiota transfer (FMT). FMT has been used successfully to restore re-occurring C. difficile infections in patients on the ICU. The first case reports on the successful use of FMT in patients with therapy-refractory sepsis have been published.[10] A key factor, however, will be establishing the exact mechanism by which certain components of the gut and/or lung microbiome play their presumed protective effects on the health of patients admitted to the ICU. This could enable us to develop targeted therapies to restore the microbiome in this very vulnerable patient population.

At the present time, we lack information on the dynamics of the microbiota in the critically ill in order to develop targeted therapies to restore the microbiome. There is a need for information on how the microbiota restores with and without interference or therapies in the critically ill. Moreover, these patients should be followed for long-term periods to monitor re-occurring infections. This information will aid in developing targeted approaches, such as the use of probiotics or FMT, to restore the microbiota and prevent infections during a patient's recovery.