Abstract
BackgroundSelective prophylactic decontamination of the digestive tract is a strategy for the prevention of secondary nosocomial infection in patients with avian influenza virus subtype H7N9 infection. Our aim was to summarize the effectiveness of these therapies in re-establishing a stable and diverse microbial community, and reducing secondary infections.MethodsComprehensive therapies were dependent on the individual clinical situation of subjects, and were divided into antiviral treatment, microbiota-targeted therapies, including pro- or pre-biotics and antibiotic usage, and immunotherapy. Quantitative polymerase chain reaction and denaturing gradient gel electrophoresis (DGGE) were used for real-time monitoring of the predominant intestinal microbiome during treatment. Clinical information about secondary infection was confirmed by analyzing pathogens isolated from clinical specimens.ResultsDifferent antibiotics had similar effects on the gut microbiome, with a marked decrease and slow recovery of the Bifidobacterium population. Interestingly, most fecal microbial DGGE profiles showed the relative stability of communities under the continual suppression of the same antibiotics, and significant changes when new antibiotics were introduced. Moreover, we found no marked increase in C-reactive protein, and no cases of bacteremia or pneumonia, caused by probiotic use in the patients, which confirmed that the probiotics used in this study were safe for use in patients with H7N9 infection. Approximately 72% of those who subsequently suffered exogenous respiratory infection by Candida species or multidrug-resistant Acinetobacter baumannii and Klebsiella pneumoniae were older than 60 years. The combination of probiotics and prebiotics with antibiotics seemed to fail in these patients.ConclusionsElderly patients infected with the influenza A (H7N9) virus are considered a high-risk group for developing secondary bacterial infection. Microbiota restoration treatment reduced the incidence of enterogenous secondary infection, but not exogenous respiratory infection. The prophylactic effects of microbiota restoration strategies for secondary infection were unsatisfactory in elderly and critically ill patients.
Highlights
Selective prophylactic decontamination of the digestive tract is a strategy for the prevention of secondary nosocomial infection in patients with avian influenza virus subtype H7N9 infection
Retrospective analysis of microbiota-targeted treatment and secondary infection Early clinical experience with influenza virus H7N9 therapy showed that patients often developed acute exacerbation with bacterial superinfection
Prophylactic selective decontamination of the digestive tract is suggested for increased survival of critically ill patients with H7N9 pneumonia
Summary
Selective prophylactic decontamination of the digestive tract is a strategy for the prevention of secondary nosocomial infection in patients with avian influenza virus subtype H7N9 infection. Antibiotics have a profound disruptive effect on the intestinal microbiome [4], which is frequently accompanied by colonization of pathogenic microbes and dysbiosis of the host immune system, contributing to the development of potentially serious diseases [5,6]. Microbiota restoration strategies, which allow beneficial bacteria to thrive, eliminate colonization by opportunistic pathogens, and enhance resistance to intestinal colonization, are required for treatment of H7N9 infection. More recent data show that probiotics can modulate host immunoregulation, alleviate intestinal inflammation, normalize gut mucosal dysfunction, and downregulate hypersensitivity reactions through control of proinflammatory and anti-inflammatory cytokines [9]. Targeted microbiota-regulating treatment could prevent or alleviate the complications of H7N9 infection
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
