Antibiotic-associated gut dysbiosis and intestinal failure in critically ill patients: Mechanisms and interventions

Table 2 Summary of multi-level clinical interventions for intestinal failure in critically ill patients

Intervention level	Primary strategy	Key measures	Primary clinical outcomes	Effect size/results	Ref.
Microbiota	ASP	Optimize selection, shorten courses, reduce broad-spectrum coverage	Broad-spectrum antibiotic use rate, AGI incidence	Use rate ↓ 20%-30%; AGI incidence ↓ 15%-25%	[37]
Microbiota	Microbial reconstitution (probiotics/synbiotics)	Probiotic/synbiotic supplementation	Antibiotic-associated diarrhea incidence	RR = 0.70-0.80	[49]
Microbiota	Microbial reconstitution (FMT)	FMT	CDAD success rate, 30-day mortality	Success rate 80%-90%; mortality significantly reduced	[42,43]
Metabolic	Nutritional support and SCFA restoration	Fiber-enriched enteral nutrition	AGI severity, butyrate-producing bacteria abundance	OR = 0.82-0.86	[46]
Metabolic/barrier	Early enteral nutrition	Initiated within 48 hours	Bloodstream infection rate, ICU length of stay	OR = 0.73 (95%CI: 0.57-0.93)	[52]
Barrier	Barrier protection	Glutamine supplementation	Intestinal permeability	Improved in high-dose, short-course subgroup; no significant benefit otherwise	[55]
Inflammatory	Immunomodulation and anti-inflammatory therapy	Low-dose corticosteroids, etc	Mortality in sepsis	RR = 0.87 (95%CI: 0.81-0.93)	[56]
Systemic	Organ support (high-quality evidence)	Hemodynamic management, mechanical ventilation	Short-term prognosis, acute-phase mortality	Standardized implementation improves short-term outcomes; does not address upstream dysbiosis	[57]
Systemic	CRRT (moderate-quality evidence)	Continuous renal replacement therapy	Cytokine clearance, fluid balance	Some attenuation of circulating mediators; effect on gut microbiota unproven	[57]

ASP: Antibiotic stewardship program; AGI: Acute gastrointestinal injury; RR: Relative risk; FMT: Fecal microbiota transplantation; CDAD: Clostridioides difficile-associated disease; SCFA: Short-chain fatty acid; ICU: Intensive care unit; OR: Odds ratio; CI: Confidence interval; CRRT: Continuous renal replacement therapy.