The gastrointestinal microbiome and the enteropathogenetic syndromes: an infectious diseases perspective

Increasing body of evidence suggests that human microbiota has an essential role in human health. The dynamic interactions between humans and their microbiota are most clearly demonstrated in the gastrointestinal tract because of the higher density. So far, we understand very little about these complex interactions, but data regarding the use of fecal microbiota transplantation (FMT) in C. difficile infections (CDI) suggest that restoring microbiome is clinically effective. Nowadays, the gastrointestinal tract is well recognized as the main “reservoir” not only for C. difficile but also for Candida spp. infections and for multidrug resistant bacteria such as carbapenemase-producing K. pneumoniae (CP-Kp). In order to stress the importance of gastrointestinal alterations in promoting intestinal colonization, overgrowth and diseases by these pathogens, we proposed the term “enteropathogenetic syndromes”, to describe enteropathogenetic endogenous opportunistic infections caused by Candida spp, C. difficile and CP-Kp. To reduce the opportunity of enteropathogenetic syndromes, there is a strong need for new antimicrobial stewardship approaches, aiming to reduce antimicrobial consumption, thus protecting and maintaining the gut microbiota. Aim of this review is to discuss the importance of gut micobiota alterations in the development of enteropathogenetic syndromes by an infectious diseases perspective.