The Shift of an Intestinal "Microbiome" to a "Pathobiome" Governs the Course and Outcome of Sepsis Following Surgical Injury.
The Shift of an Intestinal "Microbiome" to a "Pathobiome" Governs the Course and Outcome of Sepsis Following Surgical Injury.
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DOI：
10.1097/shk.0000000000000534
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
Alverdy JC
中科院分区：
文献类型：
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作者：
Krezalek MA;DeFazio J;Zaborina O;Zaborin A;Alverdy JC
手术损伤后脓毒症仍然是一个日益增长和令人担忧的问题，无论是紧急手术还是择期手术。尽管早期复苏努力和及时的抗生素治疗在最初的24-48小时内改善了结果，但迟发性败血症现在是现代重症监护病房最常见的死亡原因。这种时间变化可能部分是由于宿主长期暴露于危重疾病的应激源，随着时间的推移，这些应激源侵蚀了促进健康的肠道微生物群，并允许毒性病原体占主导地位。然后，定植的病原体会破坏免疫系统，导致宿主反应的恶化。在这里，我们假设需要新的方法来整合危重疾病期间不断发展的肠道微生物组/病理组的分子，生态和进化动力学，以了解和预防长期危重疾病后发展的晚发性败血症。
Sepsis following surgical injury remains a growing and worrisome problem following both emergent and elective surgery. Although early resuscitation efforts and prompt antibiotic therapy have improved outcomes in the first 24–48 hours, late onset sepsis is now the most common cause of death in modern intensive care units. This time shift may be, in part, a result of prolonged exposure of the host to the stressors of critical illness which, over time, erode the health promoting intestinal microbiota and allow for virulent pathogens to predominate. Colonizing pathogens can then subvert the immune system and contribute to the deterioration of the host response. Here we posit that novel approaches integrating the molecular, ecological and evolutionary dynamics of the evolving gut microbiome/pathobiome during critical illness are needed to understand and prevent the late onset sepsis that develops following prolonged critical illness.