ArticleWorld journal of gastrointestinal pathophysiology2026
Gut barrier dysfunction and multidrug-resistant bacterial translocation in adult critical illness: Mechanistic insights from a systematic review.
Article in World journal of gastrointestinal pathophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe gastrointestinal tract plays an important role in host defence during critical illness. Disruption of epithelial integrity, microbiome imbalance, and immune dysregulation have all been linked to the translocation of multidrug-resistant (MDR) organisms from intestinal colonization to invasive infection. However, whether these associations reflect true causal mechanisms remains uncertain, and available human evidence has not been comprehensively synthesized using current methodological standards.
aimTo systematically evaluate human evidence examining the relationship between intestinal barrier dysfunction, microbial colonization, and subsequent MDR infection in adult critical illness, with particular attention to study quality, heterogeneity, and potential confounding factors.
methodsThis systematic review was conducted in accordance with PRISMA guidelines. A structured literature search was performed in PubMed, EMBASE, and the Cochrane Library (2000-2025) using predefined Boolean combinations and Medical Subject Headings. Prospective and retrospective cohort studies involving intensive care units (ICU) adults were included if they evaluated intestinal colonization, biomarkers of barrier dysfunction (citrulline and intestinal fatty acid-binding protein), microbiome alterations, or endotoxemia. Study selection and data extraction were undertaken independently by two reviewers, with disagreements resolved through discussion. Risk of bias was assessed using the Newcastle-Ottawa Scale and ROBINS-I tool. Owing to methodological and clinical heterogeneity, findings were synthesized using a structured narrative approach rather than meta-analysis.
resultsAcross the included studies, intestinal colonization with carbapenem-resistant
conclusionGut barrier dysfunction appears to contribute to the pathogenesis of MDR infection in critically ill adults; however, current evidence supports association rather than causation. Early recognition of intestinal colonization and strategies aimed at preserving mucosal integrity may offer potential clinical benefit, although their effectiveness requires confirmation in well-designed prospective and interventional studies.
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