Background <p>The intestinal microbiome and its metabolic products are essential for maintaining barrier function, immune homeostasis and wound healing in the gut. In the perioperative setting, multiple factors can alter the microbial composition and function, thereby influencing the postoperative outcome.</p> Objective <p>To summarize the current evidence on the role of the intestinal microbiome in the pathogenesis of postoperative infections, to elucidate the underlying microbiological and metabolic mechanisms and to outline potential preventive and therapeutic approaches.</p> Material and methods <p>Selective literature review including experimental, translational and clinical studies.</p> Results <p>Preclinical and clinical studies demonstrate that diet, antibiotic therapy and surgical stress can alter the intestinal microbial equilibrium. The resulting functional dysbiosis promotes activation of bacterial virulence programs, enhances inflammatory responses and impairs healing processes. These changes can contribute to postoperative infections, anastomotic leakage and sepsis. Early findings suggest that microbiome-based interventions could reduce the risk of infections.</p> Discussion <p>Current evidence indicates that alterations of the intestinal microbiome and metabolome during the perioperative period could contribute to infectious complications. Targeted modulation of the microbiome before and after surgery could represent a&#xa0;novel approach to infection prevention. Prospective studies with standardized methodologies are needed to integrate microbiome-based strategies into surgical routine practice.</p>