The role of the microbiota in surgical recovery

Abstract

Purpose of review The purpose of this review is to highlight new research findings in the complex bidirectional crosstalk that occurs between the intestinal microbiome and the host immune system in the context of surgical recovery and outcomes. Recent findings Significant evidence has been generated emphasizing the central role of the intestinal microbiome on surgical outcomes such as wound healing, surgical site infections and anastomotic leak. Current preventive strategies including the use of some parenteral antibiotics, may actually exacerbate the problem by selecting for drug-resistant pathogens. Summary A delicate balance exists between the human host and its microbial counterparts that is directly related to post-surgical healing. This balance can be easily altered in favor of the pathogen through peri-operative and surgical interventions leading to intestinal dysbiosis and loss of colonization resistance. Current strategies to prevent infectious complications with the escalating use of broader and more powerful antibiotics is not an evolutionarily stable strategy. A more complete understanding of the ecological and molecular interactions of the host with its microbiome is necessary to uncover new therapeutic strategies that preserve the composition and function of the intestinal microbiome and constrain virulent pathogens through the course of surgical injury.

An altered composition of fecal microbiota, organic acids, and the effect of probiotics in the guinea pig model of postoperative ileus

“…A substantial alteration in gut microbiota induced by surgical stress has been suggested as a factor in infectious complications after GI surgery 20 . The development of anastomotic leakage has also been found to be associated with gut microbiota 18,21 . Accordingly, much effort has been made to find out about the bacterial shift and to modify the community using probiotics or synbiotics in patients with these surgical complications 22 .…”

Naturopathic Treatment and Complementary Medicine in Surgical Practice

“…Wound healing and and healing of colorectal anastomosis seem to be influenced by the composition of the gut microbiome (7,8). Controlled studies have shown clear indications in humans that the intestinal microbiome changes postoperatively (9); in particular, levels of lactobacilli and bifidobacteria appear to decrease.…”

The Influence of Host Stress on the Mechanism of Infection: Lost Microbiomes, Emergent Pathobiomes, and the Role of Interkingdom Signaling

“…Many forms of host stress, independent of antimicrobial administration, have been shown to affect the composition and function of the microbiota ( Mackenzie et al, 2017 ). For example, in patients undergoing gastrointestinal surgery, the use of opioid analgesics, withholding of enteral nutrition, and gastric acid suppression have all been shown to have profound effects on the microbiome ( Krezalek and Alverdy, 2016 ; Levesque et al, 2016 ). Reuland et al (2016) reported that the use antacids is associated with increased risk of extended-spectrum-β-lactamase producing Enterobacteriaceae carriage.…”

“… Rate and degree of microbiota refaunation on recovery from severe catabolic stress such as following human critical illness ( Guyton and Alverdy, 2016 ; Krezalek and Alverdy, 2016 ; Alverdy and Krezalek, 2017 ). (A) Demonstrates typical response to successful modern medical care with limited antibiotic exposure and rapid resolution of the infection or injury ( Modi et al, 2014 ).…”