Influence of the critically ill state on host-pathogen interactions within the intestine: gut-derived sepsis redefined
Abstract
Severe and prolonged states of catabolic stress have been shown to have profound effects on the intestinal tract microflora and intestinal function. Gut-derived sepsis is a term used to describe a state of systemic inflammation with organ dysfunction after severe catabolic stress hypothesized to be initiated and perpetuated by the intestinal tract microflora. Popular notions of the mechanism of this process have suggested that stress promotes the translocation of intestinal bacteria or their toxins into the systemic compartment resulting in the release of proinflammatory cytokines which participate in the systemic inflammatory response syndrome. This review is an attempt to redefine the mechanism of gut-derived sepsis by focusing on molecular events that result from host-pathogen interactions within the intestinal tract itself. This evidence-based review posits that gut-derived bacteremia, even with potent nosocomial pathogens, is an event of low proinflammatory potential and, itself, is an insufficient stimulus for the systemic inflammatory response and organ failure state typically seen after severe and prolonged catabolic stress. Mechanisms of this apparent paradox are discussed.
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Translocation of microbes and microbial products is not necessary for the microbiome to cause systemic inflammation and injury.
“translocation of microbes and microbial products is not necessary for the microbiome to cause systemic inflammation and injury.”
From The microbiome and critical illness (2016) · cites this paper as [105]
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- Authors
- Alverdy, J. C., Laughlin, R. S., & Wu, L.
- Affiliations
- University of Chicago Medical Center (US)
- ORCID
- Alverdy, John C.
- Venue
- Critical Care Medicine
- Published
- 2003-02
- Volume
- 31
- Issue
- 2
- Pages
- 598-607
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W1997883951
- Cited by
- 200
- References
- 61
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 8 · 2016: 6 · 2015: 7 · 2014: 6 · 2013: 10 · 2012: 20
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of General Medical Sciences (R01GM062344, R01-GM-62344-01)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- gut-derived sepsis, host-pathogen interaction, gut microbiota, catabolic stress, nosocomial pathogens, systemic inflammatory response syndrome, inflammatory cytokines, organ dysfunction, intestinal barrier, critically ill patients
- MeSH terms
- Bacteria, Epithelium, Humans, Intestines, Virulence, Reperfusion Injury, Bacteremia, Critical Illness, Sepsis, Bacterial Translocation, Pancreatitis, Acute Necrotizing
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