Progress on the correlation between sepsis and gut microbiota: a narrative review

Background Sepsis is a life-threatening organ dysfunction with high mortality. Gut microbiota plays a key role in sepsis pathogenesis, but evidence is often mixed. Methods 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. Results Sepsis and gut microbiota form a bidirectional vicious cycle. Sepsis induces dysbiosis via ischemia, inflammation, and broad-spectrum antibiotics – 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). Conclusion 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.