The gastrointestinal system might play a key role in the pathogenesis owing to a breakdown of intestinal barrier function. Gurusamy and colleagues concluded from their database review that the use of prebiotics and probiotics might be effectful in the prevention of sepsis [58] . However, our patients received no prebiotics or probiotics, but this might be a beneficial therapeutical option in the future. Most importantly these patients should be management according to the guidelines of the Survival Sepsis Campaign [59, 60] .