{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:19:36Z","timestamp":1791872376598,"version":"4.3.4"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis is a life-threatening organ dysfunction with high mortality. Gut microbiota plays a key role in sepsis pathogenesis, but evidence is often mixed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review is based on a structured literature search (PubMed, Web of Science, Cochrane; from database inception to March 15, 2025). Findings are stratified into clinical (human), preclinical (animal), and unsafe\/unproven categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sepsis and gut microbiota form a bidirectional vicious cycle. Sepsis induces dysbiosis via ischemia, inflammation, and broad-spectrum antibiotics \u2013 the strongest iatrogenic driver. Dysbiosis in turn amplifies organ dysfunction through gut-brain, gut-lung, gut-liver, gut-kidney, and gut-heart\/spleen axes. Clinically, adequate source control and antibiotic de-escalation are mandatory before any microbiota-directed therapy. Microbiota-targeted interventions show promise but carry significant risks: live probiotics are contraindicated in septic shock, severe pancreatitis, and immunocompromised patients (PROPATRIA trial).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This evidence-stratified review provides a clinical roadmap: prioritize source control and antibiotic stewardship; avoid live probiotics in high-risk sepsis. Future research requires large RCTs and personalized strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmicb.2026.1862891","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:01:17Z","timestamp":1780466477000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Progress on the correlation between sepsis and gut microbiota: a narrative review"],"prefix":"10.3389","volume":"17","author":[{"given":"Yaning","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Outpatient Nursing, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawei","family":"Li","sequence":"additional","affiliation":[{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]},{"name":"Department of Pediatric Outpatient Nursing, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Yang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]},{"name":"Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Pediatric Intensive Care Unit Nursing, WCSUH-Tianfu\u00b7Sichuan Provincial Children\u2019s Hospital","place":["Meishan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1016\/s0140-6736(08)60207-x","article-title":"Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial","volume":"371","author":"Besselink","year":"2008","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1021\/acs.jafc.3c08462","article-title":"Rattan pepper polysaccharide regulates DSS-induced intestinal inflammation and depressive behavior through microbiota-gut-brain axis","volume":"72","author":"Chang","year":"2024","journal-title":"J. Agric. Food Chem."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1279677","DOI":"10.3389\/fimmu.2023.1279677","article-title":"Alveolar macrophage modulation via the gut-lung axis in lung diseases","volume":"14","author":"Chen","year":"2023","journal-title":"Front. Immunol."},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3390\/cells12060901","article-title":"Targeting lung-gut axis for regulating pollution particle-mediated inflammation and metabolic disorders","volume":"12","author":"Cheng","year":"2023","journal-title":"Cells"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s13017-023-00509-4","article-title":"Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines","volume":"18","author":"Coccolini","year":"2023","journal-title":"World J. Emerg. Surg."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1056\/NEJMoa0800394","article-title":"Decontamination of the digestive tract and oropharynx in ICU patients","volume":"360","author":"de Smet","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"14480","DOI":"10.1021\/acs.jafc.0c05677","article-title":"Effects of oat fiber intervention on cognitive behavior in LDLR(\u2212\/\u2212) mice modeling atherosclerosis by targeting the microbiome-gut-brain axis","volume":"68","author":"Gao","year":"2020","journal-title":"J. Agric. Food Chem."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1186\/s12974-022-02472-4","article-title":"A crosstalk between gut and brain in sepsis-induced cognitive decline","volume":"19","author":"Giridharan","year":"2022","journal-title":"J. Neuroinflammation"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.1038\/s41423-023-01070-5","article-title":"A metabolite from commensal Candida albicans enhances the bactericidal activity of macrophages and protects against sepsis","volume":"20","author":"Gu","year":"2023","journal-title":"Cell. Mol. Immunol."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1451356","DOI":"10.3389\/fimmu.2024.1451356","article-title":"Protective effect of gut microbiota restored by fecal microbiota transplantation in a sepsis model in juvenile mice","volume":"15","author":"Han","year":"2024","journal-title":"Front Immunol Abbreviation"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"100533","DOI":"10.1016\/j.crfs.2023.100533","article-title":"Lactoferrin alleviates Western diet-induced cognitive impairment through the microbiome-gut-brain axis","volume":"7","author":"He","year":"2023","journal-title":"Curr. Res. Food Sci."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1080\/10408398.2025.2556470","article-title":"Targeting the gut-liver axis with dietary polyphenols to ameliorate metabolic dysfunction-associated steatotic liver disease: advances in molecular mechanisms","author":"Hu","year":"2026","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"100987","DOI":"10.1016\/j.jhepr.2023.100987","article-title":"Microbiota modulation by dietary oat beta-glucan prevents steatotic liver disease progression","volume":"6","author":"Jaeger","year":"2024","journal-title":"JHEP Rep."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2212","DOI":"10.1097\/cm9.0000000000000928","article-title":"Gut-lymph-lung pathway mediates sepsis-induced acute lung injury","volume":"133","author":"Jin","year":"2020","journal-title":"Chin. Med. J."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1582119","DOI":"10.3389\/fimmu.2025.1582119","article-title":"Gut microbiota-driven neuroinflammation in Alzheimer's disease: from mechanisms to therapeutic opportunities","volume":"16","author":"Lei","year":"2025","journal-title":"Front. Immunol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3068","DOI":"10.1016\/j.apsb.2024.03.025","article-title":"Gut commensal metabolite rhamnose promotes macrophages phagocytosis by activating SLC12A4 and protects against sepsis in mice","volume":"14","author":"Li","year":"2024","journal-title":"Acta Pharm. Sin. B"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"115072","DOI":"10.1016\/j.biopha.2023.115072","article-title":"Erythropoietin-mediated IL-17 F attenuates sepsis-induced gut microbiota dysbiosis and barrier dysfunction","volume":"165","author":"Ling","year":"2023","journal-title":"Biomed. Pharmacother."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1016\/j.gpb.2020.06.011","article-title":"Classification of the gut microbiota of patients in intensive care units during development of sepsis and septic shock","volume":"18","author":"Liu","year":"2020","journal-title":"Genomics Proteomics Bioinformatics"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"14874","DOI":"10.1021\/acs.jafc.0c06332","article-title":"Probiotics exert protective effect against sepsis-induced cognitive impairment by reversing gut microbiota abnormalities","volume":"68","author":"Liu","year":"2020","journal-title":"J. Agric. Food Chem."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"tkad022","DOI":"10.1093\/burnst\/tkad022","article-title":"Postbiotics as potential new therapeutic agents for sepsis","volume":"11","author":"Lou","year":"2023","journal-title":"Burns Trauma Abbreviation"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1063543","DOI":"10.3389\/fimmu.2022.1063543","article-title":"Fecal microbiota transplantation and short-chain fatty acids reduce sepsis mortality by remodeling antibiotic-induced gut microbiota disturbances","volume":"13","author":"Lou","year":"2022","journal-title":"Front. Immunol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"10826","DOI":"10.1021\/acs.est.5c00798","article-title":"Microbial dysbiosis in the lung and gut in response to inhalable particulate matters in pneumoconiosis patients and animals","volume":"59","author":"Ma","year":"2025","journal-title":"Environ. Sci. Technol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"574500","DOI":"10.3389\/fimmu.2020.574500","article-title":"Gut microbiota-dependent trimethylamine N-oxide associates with inflammation in common variable immunodeficiency","volume":"11","author":"Macpherson","year":"2020","journal-title":"Front. Immunol."},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.64611","article-title":"Dichloroacetate reverses sepsis-induced hepatic metabolic dysfunction","volume":"10","author":"Mainali","year":"2021","journal-title":"Elife"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"tkab036","DOI":"10.1093\/burnst\/tkab036","article-title":"Crosstalk between gut microbiota and sepsis","volume":"9","author":"Niu","year":"2021","journal-title":"Burns Trauma"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.153944","article-title":"Dichloroacetate improves systemic energy balance and feeding behavior during sepsis","volume":"7","author":"Oh","year":"2022","journal-title":"JCI Insight"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"101982","DOI":"10.1016\/j.xcrm.2025.101982","article-title":"The gut microbiota-immune-brain axis: therapeutic implications","volume":"6","author":"O'Riordan","year":"2025","journal-title":"Cell Rep Med Abbreviation"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"561652","DOI":"10.3389\/fimmu.2020.561652","article-title":"Candida administration worsens cecal ligation and puncture-induced sepsis in obese mice through gut dysbiosis enhanced systemic inflammation, impact of pathogen-associated molecules from gut translocation and saturated fatty acid","volume":"11","author":"Panpetch","year":"2020","journal-title":"Front. Immunol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"111890","DOI":"10.1016\/j.biopha.2021.111890","article-title":"New insights into lipopolysaccharide inactivation mechanisms in sepsis","volume":"141","author":"P\u00e9rez-Hern\u00e1ndez","year":"2021","journal-title":"Biomed. Pharmacother."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1186\/s12964-025-02224-w","article-title":"Inhibition of Farnesoid-x-receptor signaling during abdominal sepsis by dysbiosis exacerbates gut barrier dysfunction","volume":"23","author":"Qian","year":"2025","journal-title":"Cell Commun. Signal"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1111\/apt.14201","article-title":"Systematic review with meta-analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection","volume":"46","author":"Quraishi","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"954339","DOI":"10.3389\/fimmu.2022.954339","article-title":"Possible role of gut microbes and host's immune response in gut-lung homeostasis","volume":"13","author":"Rastogi","year":"2022","journal-title":"Front. Immunol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"2440125","DOI":"10.1080\/19490976.2024.2440125","article-title":"Role of gut microbes in acute lung injury\/acute respiratory distress syndrome","volume":"16","author":"Ren","year":"2024","journal-title":"Gut Microbes Abbreviation"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s13017-021-00387-8","article-title":"WSES\/GAIS\/SIS-E\/WSIS\/AAST global clinical pathways for patients with intra-abdominal infections","volume":"16","author":"Sartelli","year":"2021","journal-title":"World J. Emerg. Surg."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s13017-019-0228-3","article-title":"2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients","volume":"14","author":"Sartelli","year":"2019","journal-title":"World J. Emerg. Surg."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1266230","DOI":"10.3389\/fimmu.2024.1266230","article-title":"Gut microbiota and sepsis and sepsis-related death: a Mendelian randomization investigation","volume":"15","author":"Shang","year":"2024","journal-title":"Front. Immunol."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e70168","DOI":"10.1002\/mco2.70168","article-title":"Gut microbiota dysbiosis: pathogenesis, diseases, prevention, and therapy","volume":"6","author":"Shen","year":"2025","journal-title":"MedComm"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s13054-023-04412-x","article-title":"Altered intestinal microbiome and metabolome correspond to the clinical outcome of sepsis","volume":"27","author":"Sun","year":"2023","journal-title":"Crit. Care"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1178691","DOI":"10.3389\/fimmu.2023.1178691","article-title":"Gut microbiota in perioperative neurocognitive disorders: current evidence and future directions","volume":"14","author":"Sun","year":"2023","journal-title":"Front. Immunol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1186\/s13054-020-03327-1","article-title":"Gut-liver crosstalk in sepsis-induced liver injury","volume":"24","author":"Sun","year":"2020","journal-title":"Crit. Care"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1165\/rcmb.2020-0288TR","article-title":"The gut microbiome and ozone-induced airway hyperresponsiveness. Mechanisms and therapeutic prospects","volume":"64","author":"Tashiro","year":"2021","journal-title":"Am. J. Respir. Cell Mol. Biol."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12979-025-00514-y","article-title":"Gut-vitamin D interplay: key to mitigating immunosenescence and promoting healthy ageing","volume":"22","author":"Ullah","year":"2025","journal-title":"Immun. Ageing"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1056\/NEJMoa1205037","article-title":"Duodenal infusion of donor feces for recurrent Clostridium difficile","volume":"368","author":"van Nood","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"105547","DOI":"10.5492\/wjccm.v14.i4.105547","article-title":"Sepsis and the diverse organ-gastrointestinal tract axis","volume":"14","author":"Wang","year":"2025","journal-title":"World J Crit Care Med."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"106499","DOI":"10.1016\/j.nbd.2024.106499","article-title":"Gut-brain axis in the pathogenesis of sepsis-associated encephalopathy","volume":"195","author":"Wang","year":"2024","journal-title":"Neurobiol. Dis."},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.3390\/cells11213419","article-title":"Changes in gut microbiota and systemic inflammation after synbiotic supplementation in patients with systemic lupus erythematosus: a randomized, double-blind, placebo-controlled trial","volume":"11","author":"Widhani","year":"2022","journal-title":"Cells"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"104363","DOI":"10.1016\/j.ebiom.2022.104363","article-title":"Immunopathophysiology of human sepsis","volume":"86","author":"Wiersinga","year":"2022","journal-title":"EBioMedicine"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"6737","DOI":"10.1038\/s41467-024-51209-9","article-title":"Gut-derived memory \u03b3\u03b4 T17 cells exacerbate sepsis-induced acute lung injury in mice","volume":"15","author":"Xie","year":"2024","journal-title":"Nat. Commun."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"117284","DOI":"10.1016\/j.bcp.2025.117284","article-title":"New insights into gut-liver axis in advanced liver diseases: a promising therapeutic target","volume":"242","author":"Xing","year":"2025","journal-title":"Biochem. Pharmacol."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"2312320","DOI":"10.1080\/13510002.2024.2312320","article-title":"Glutamine sustains energy metabolism and alleviates liver injury in burn sepsis by promoting the assembly of mitochondrial HSP60-HSP10 complex via SIRT4 dependent protein deacetylation","volume":"29","author":"Yang","year":"2024","journal-title":"Redox Rep"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1016\/j.jgg.2022.03.012","article-title":"Mesenteric lymph system constitutes the second route in gut-liver axis and transports metabolism-modulating gut microbial metabolites","volume":"49","author":"Yu","year":"2022","journal-title":"J. Genet. Genomics"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1016\/j.jgg.2021.07.001","article-title":"Microbiota-gut-brain axis in autism spectrum disorder","volume":"48","author":"Yu","year":"2021","journal-title":"J. Genet. Genomics"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1186\/s13054-022-04090-1","article-title":"The gut-liver axis in sepsis: interaction mechanisms and therapeutic potential","volume":"26","author":"Zhang","year":"2022","journal-title":"Crit Care Abbreviation"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"1190230","DOI":"10.3389\/fimmu.2023.1190230","article-title":"Causal associations of gut microbiota and metabolites on sepsis: a two-sample Mendelian randomization study","volume":"14","author":"Zhao","year":"2023","journal-title":"Front. Immunol."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"3954","DOI":"10.1039\/d0fo03384g","article-title":"Ginseng ameliorates exercise-induced fatigue potentially by regulating the gut microbiota","volume":"12","author":"Zhou","year":"2021","journal-title":"Food Funct."},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.3390\/cells14060466","article-title":"Sirtuins and gut microbiota: dynamics in health and a journey from metabolic dysfunction to hepatocellular carcinoma","volume":"14","author":"Zhra","year":"2025","journal-title":"Cells"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s13054-024-05006-x","article-title":"Gut-derived immune cells and the gut-lung axis in ARDS","volume":"28","author":"Ziaka","year":"2024","journal-title":"Crit. Care"}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1862891\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:01:18Z","timestamp":1780466478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1862891\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":58,"alternative-id":["10.3389\/fmicb.2026.1862891"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2026.1862891","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]},"article-number":"1862891"}}