The influence of gut endoecology on the development of infectious complications and multiple organ failure in wounded patients with polytrauma

The intestine is one of the most important target organs of stress caused by hemorrhagic shock, traumatic shock, burns, and severe injuries to bones and soft tissues. This review examines the microbial endoecology of the gastrointestinal tract in wounded patients with polytrauma. Severe intestinal injury plays a major role in the development of infectious complications and multiple organ failure in wounded patients with polytrauma. Such complications result from interactions between impaired gastrointestinal motility, damage to the intestinal epithelium, the immune system, and the gastrointestinal microbiota. The formation of gastrointestinal endoecology depends on the influx of microorganisms into the system, the reproduction rate of individual representatives, and their elimination into the environment. The gut microbiome can be disrupted under the influence of the intestinal environment in critically injured patients. Three hypotheses are highlighted—bacterial translocation, lymphocyte-derived bacteremia, and in situ virulence—that explain the role of the gastrointestinal biota-tissue complex in the pathogenesis of sepsis and multiple organ failure in critically injured patients. Early diagnosis and stratification of patients with biotissue complex disruption of the intestine in systemic response to injury may improve outcomes through the timely initiation of appropriate specific treatment.