Progress on the correlation between sepsis and gut microbiota: a narrative review

Area of Science:

• Microbiology
• Critical Care Medicine
• Gastroenterology

Background:

• Sepsis is a critical condition with high mortality, where gut microbiota significantly influences its development.
• The precise role of gut microbiota in sepsis pathogenesis remains incompletely understood, with conflicting evidence.
• Gut microbiota dysbiosis is increasingly recognized as a key factor in sepsis.

Purpose of the Study:

• To provide a structured review of the bidirectional relationship between sepsis and gut microbiota.
• To stratify evidence into clinical, preclinical, and unsafe/unproven categories for microbiota-directed therapies in sepsis.
• To offer a clinical roadmap for managing sepsis with consideration of gut microbiota.

Main Methods:

• A structured literature search was conducted across PubMed, Web of Science, and Cochrane databases.
• The search covered literature from database inception up to March 15, 2025.
• Findings were categorized into clinical (human), preclinical (animal), and unsafe/unproven evidence.

Main Results:

• Sepsis and gut microbiota engage in a detrimental feedback loop; sepsis-induced dysbiosis exacerbates organ dysfunction via multiple axes.
• Key drivers of sepsis-induced dysbiosis include ischemia, inflammation, and broad-spectrum antibiotics.
• While microbiota interventions show potential, live probiotics are contraindicated in high-risk sepsis patients (e.g., septic shock, severe pancreatitis, immunocompromised individuals).

Conclusions:

• Clinical management of sepsis requires prioritizing source control and judicious antibiotic use (stewardship).
• Live probiotics should be avoided in high-risk sepsis patients due to significant contraindications.
• Future research should focus on large randomized controlled trials and personalized microbiota-targeted strategies for sepsis treatment.