Infection
Ryan Maves, MD, FCCM
Professor of Medicine and Anesthesiology
Wake Forest University School of Medicine
Winston Salem, North Carolina
The gut microbiome regulates a number of homeostatic mechanisms in the healthy host including immune function and gut barrier protection. Loss of normal gut microbial structure and function has been associated with diseases as diverse as Clostridioides difficile infection, asthma, and epilepsy. This session will focus on three key areas of the link between the gut microbiome and sepsis. Before sepsis onset, gut microbiome alteration increases sepsis susceptibility through several mechanisms, including allowing for expansion of pathogenic intestinal bacteria, priming the immune system for a robust proinflammatory response, and decreasing production of beneficial microbial products such as short-chain fatty acids. Once sepsis is established, gut microbiome disruption worsens and increases susceptibility to end-organ dysfunction. There is limited evidence that microbiome-based therapeutics, including probiotics and selective digestive decontamination, may decrease sepsis risk and improve sepsis outcomes.