Abstract
BackgroundA novel avian-origin influenza A (H7N9) virus emerged and spread among humans in Eastern China in 2013. Prophylactic treatment with antibiotics and probiotics for secondary infection is as important as antiviral treatment. This study aims to assess the ability of probiotic treatment to restore internal homeostasis under antibiotic pressure and to reduce/ameliorate the risk of secondary infections resulting from infection with the H7N9 virus.MethodsThis is a retrospective study in archival samples. Between April 1 and May 10, 2013, 113 stool, sputum, and blood specimens were collected and analyzed by denaturing gradient gel electrophoresis (DGGE) to determine the composition of the patient microbiomes. Microbial diversity was calculated using Gel-Pro analyzer and Past software. Cluster analysis of DGGE pattern profiles was employed to create a phylogenetic tree for each patient, and multidimensional scaling (MDS) and principal component analysis (PCA) were performed to visualize relationships between individual lanes.ResultsFive patients had secondary infections, including Klebsiella pneumonia, Acinetobacter baumanii and Candida albicans infection. The DGGE profiles of fecal samples obtained at different time points from the same individual were clearly different, particularly for patients with secondary infections. Shannon’s diversity index and evenness index were lower in all infected groups compared to the control group. After B. subtilis and E. faecium or C. butyricum administration, the fecal bacterial profiles of patients who had not been treated with antibiotics displayed a trend of increasing diversity and evenness. C. butyricum failed to reduce/ameliorate secondary infection in H7N9-infected patients, but administration of B. subtilis and E. faecium appeared to reduce/ameliorate secondary infection in one patient.ConclusionH7N9 infection might decrease intestinal microbial diversity and species richness in humans. C. butyricum failed to reduce/ameliorate secondary infection in H7N9-infected patients. B. subtilis and E. faecium may also play a role in reducing/ameliorating secondary infection in these patients.
Highlights
The China Health and Planning Commission notified the World Health Organization (WHO) of three novel human influenza infections on March 31, 2013
This study aims to assess the ability of probiotic treatment to restore internal homeostasis under antibiotic pressure and to reduce/ameliorate the risk of secondary infections resulting from infection with the H7N9 virus
The denaturing gradient gel electrophoresis (DGGE) profiles of fecal samples obtained at different time points from the same individual were clearly different, for patients with secondary infections
Summary
The China Health and Planning Commission notified the World Health Organization (WHO) of three novel human influenza infections on March 31, 2013. Extensive therapeutic interventions including antiviral treatment, oxygen therapy, mechanical ventilation, antibiotics, glucocorticoids, intravenous immunoglobulins, extracorporeal membrane oxygenation, continuous renal replacement therapy, and artificial liver support system therapy were employed. Despite these interventions, a high mortality rate among H7N9-infected patients was observed [2, 3]. H7N9 patients were generally admitted for longer hospital stays than patients infected with either H5N1 or pandemic H1N1 (pH1N1) [4]. This increased duration of hospitalization frequently resulted in an increased incidence of secondary infections. This study aims to assess the ability of probiotic treatment to restore internal homeostasis under antibiotic pressure and to reduce/ameliorate the risk of secondary infections resulting from infection with the H7N9 virus
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