Microflora In Patients Research Articles

Bifidumbacterin forte in the treatment of acute viral hepatitis

Relevance. In patients with acute viral hepatitis A and B, favorable conditions are created for the development of dysbacteriosis. As a result, the toxic load on the liver increases. For effective treatment of acute viral hepatitis A and B, it is necessary to examine for intestinal dysbiosis before and after treatment and subsequent correction of identified disorders. Aim. To study the clinical course, functional state of the liver, intestinal microflora in patients with acute viral hepatitis A and B and the effectiveness of using bifidumbacterin forte for the correction of intestinal microflora. Materials and methods. The work used clinical and laboratory data from 54 patients with acute viral hepatitis A and B. The main group of patients received bifidumbacterin forte against the background of basic therapy. Patients in the comparison group were on traditional therapy. Clinical, biochemical, bacteriological parameters were observed before the start of therapy and 15 days after its start, serological markers - upon admission. Results. During the therapy, in patients of the main group, the disappearance of intoxication, lethargy, weakness, pain, and normalization of liver size were observed earlier in comparison with the control group. Symptoms of pigment metabolism disorders disappeared significantly earlier: yellowness of the skin, itching of the skin, changes in the color of urine and feces. A dynamic study of liver tests demonstrated a more rapid reverse development of biochemical disorders of the functional state of the liver in patients who received bifidumbacterin forte as part of complex treatment. Conclusion. The use of bifidumbacterin forte in patients with acute viral hepatitis A and B against the background of basic treatment has a positive effect on some clinical manifestations, biochemical parameters, and individual components of the intestinal microflora.

Experience of microbiological monitoring of the respiratory tract microflora in patients with cystic fibrosis during therapy with the combination drug elexacaftor/tezacaftor/ivacaftor + ivacaftor

Bacterial complications of the respiratory tract are negative prognostic factors leading to a decrease in pulmonary function, duration, and quality of life of patients with cystic fibrosis. To date, a sufficient number of studies have not been accumulated to reliably prove or reject microbiological improvement during targeted therapy. The aim of the study was to collect continuous microbiological data from patients with cystic fibrosis in the Samara region receiving treatment with elexacaftor/tezacaftor/ivacaftor + ivacaftor from November-December 2021. The article presents eight clinical observations. At the time of therapy initiation, seven patients had chronic respiratory tract infection associated with Burkholderia cenocepacia ST 208, combined with chronic Pseudomonas aeruginosa infection in two of them. One patient had a chronic P. aeruginosa infection in association with Aspergillus fumigatus. Conclusion. An expansion of the species composition in the respiratory samples was demonstrated in all cases. The majority of patients showed microbiological improvement. Thus, biochemical and, as a result, microecological changes in the lungs against the normalization of chlorine channel function allow suggesting that key pathogens may be eradicated during the therapy with elexacaftor/tezacaftor/ivacaftor + ivacaftor.

Importance of Gut Microbiota in Patients with Inflammatory Bowel Disease.

Inflammatory bowel diseases (IBDs), such as Crohn's disease (CD) and ulcerative colitis (UC), are chronic diseases of the digestive system with a multifactorial and not fully understood etiology. There is research suggesting that they may be initiated by genetic, immunological, and lifestyle factors. In turn, all of these factors play an important role in the modulation of intestinal microflora, and a significant proportion of IBD patients struggle with intestinal dysbiosis, which leads to the conclusion that intestinal microflora disorders may significantly increase the risk of developing IBD. Additionally, in IBD patients, Toll-like receptors (TLRs) produced by intestinal epithelial cells and dendritic cells treat intestinal bacterial antigens as pathogens, which causes a disruption of the immune response, resulting in the development of an inflammatory process. This may result in the occurrence of intestinal dysbiosis, which IBD patients are significantly vulnerable to. In this study, we reviewed scientific studies (in particular, systematic reviews with meta-analyses, being studies with the highest level of evidence) regarding the microflora of patients with IBD vs. the microflora in healthy people, and the use of various strains in IBD therapy.

СОВРЕМЕННЫЕ ТЕНДЕНЦИИ АНТИБИОТИКОУСТОЙЧИВОСТИ ПАТОГЕННЫХ МИКРООРГАНИЗМОВ ПАЦИЕНТОВ ХИРУРГИЧЕСКОГО ПРОФИЛЯ

Background. To carry out adequate antibacterial therapy directed against pathogenic microflora in patients with surgical infection it is necessary to take into account indicators of antibiotic resistance of leading etiological agents. The aim of the work is to study the spectrum and current dynamics of changes in antibiotic resistance of purulent pathogens in soft tissues of surgical patients. Material and methods. An analysis of the results of antibiotic resistance of the seeded leading microflora in patients with purulent processes of soft tissues was made. Results. Isolates of Staphylococcus aureus from surgical patients are characterized by high resistance to all β-lactam antibiotics, the combination drug trimethoprim-sulfamethoxazole, and macrolides. The resistance of Klebsiella pneumoniae and Proteus mirabilis to all studied β-lactam antibiotics, as well as fluoroquinolones, aminoglycosides, tetracyclines, nitrofurans, and chloramphenicol ranges from 37 to 100%. Escherichia coli resistance to β-lactams, fluoroquinolones, carbapenems, and aminoglycosides reaches 50-73%. A high level of antibacterial resistance is also characteristic of other bacteria most often cultured in surgical patients. Conclusions. The most frequently cultured strains of both gram-positive and gram-negative groups of microorganisms from surgical patients are characterized by a high level of antibacterial resistance, reaching 100%. Currently, cases of polyantibiotic resistance and resistance even to reserve antibiotics are not uncommon. All this dictates the need to search for new classes of substances that have an antimicrobial effect, and metal nanoparticles may be one of them.

Altered mucosal bacteria and metabolomics in patients with Peutz–Jeghers syndrome

BackgroundPeutz–Jeghers syndrome (PJS) is a rare genetic disorder characterized by the development of pigmented spots, gastrointestinal polyps and increased susceptibility to cancers. Currently, most studies have investigated intestinal microbiota through fecal microbiota, and there are few reports about mucosa-associated microbiota. It remains valuable to search for the key intestinal microbiota or abnormal metabolic pathways linked to PJS.AimThis study aimed to assess the structure and composition of mucosa-associated microbiota in patients with PJS and to explore the potential influence of intestinal microbiota disorders and metabolite changes on PJS.MethodsThe bacterial composition was analyzed in 13 PJS patients and 12 controls using 16S rRNA gene sequencing (Illumina MiSeq) for bacteria. Differential analyses of the intestinal microbiota were performed from the phylum to species level. Liquid chromatography-tandem mass spectrometry (LC‒MS) was used to detect the differentially abundant metabolites of PJS patients and controls to identify different metabolites and metabolic biomarkers of small intestinal mucosa samples.ResultsHigh-throughput sequencing confirmed the special characteristics and biodiversity of the mucosa microflora in patients with PJS. They had lower bacterial biodiversity than controls. The abundance of intestinal mucosal microflora was significantly lower than that of fecal microflora. In addition, lipid metabolism, amino acid metabolism, carbohydrate metabolism, nucleotide metabolism and other pathways were significantly different from those of controls, which were associated with the development of the enteric nervous system, intestinal inflammation and development of tumors.ConclusionThis is the first report on the mucosa-associated microbiota and metabolite profile of subjects with PJS, which may be meaningful to provide a structural basis for further research on intestinal microecology in PJS.

Regulation of intestinal flora in patients with chronic atrophic gastritis by modified Chai Shao Liu Jun Zi decoction based on 16S rRNA sequencing.

Chai Shao Liu Jun Zi decoction (CSLJZD) is an effective Chinese medicine for the treatment of chronic atrophic gastritis (CAG). However, the effect of CSLJZD on the intestinal flora of patients with CAG remains unclear. We used 16S rRNA gene sequencing to investigate the regulatory effects of CSLJZD on intestinal microflora in patients with CAG. Eight patients with CAG were randomly selected as the model group and 8 healthy medical examiners as the control group; the treatment group comprised patients with CAG after CSLJZD treatment. High-throughput sequencing and bioinformatics analysis of the V3V4 region of the 16S rRNA gene of intestinal bacteria obtained from the intestinal isolates of fecal specimens from all participants were performed separately. A rarefaction curve, species accumulation curve, Chao1 index, and ACE index were calculated to assess the alpha diversity. Principal component analysis (PCA), non-metric multi-dimensional scaling, and the unweighted pair group method with arithmetic mean were used to examine beta diversity. The LEfSe method was used to identify the differentially expressed bacteria. Differential function analysis was performed using PCA based on KEGG function prediction. Rarefaction and species accumulation curves showed that the sequencing data were reasonable. The Chao1 and ACE indices were significantly increased in patients with CAG compared with those in the healthy group. Following CSLJZD and vitacoenzyme treatment, Chao1 and ACE indices decreased. The PCA, non-metric multi-dimensional scaling, and unweighted pair group method with arithmetic mean results showed that the CAG group was distinct from the healthy and treatment groups. The LEfSe results showed that the abundances of the genus Bilophila, family Desulfovibrionaceae, order Desulfovibrionales and genus Faecalibacterium were significantly higher in the healthy group. The abundance of genus Klebsiella, order Deltaproteobacteria, genus Gemmiger, and other genera was significantly higher in the treatment group. Treatment with CSLJZD had a therapeutic effect on the intestinal flora of patients with CAG.

Conjunctival and nasal microflora in patients on topical cyclosporine for dry eye.

Introduction: Dry eye is a common ocular condition causing discomfort and visual disturbances. Anti-inflammatory agents like Cyclosporine A (CsA) are often used in its treatment. However, the impact of CsA on ocular flora remains understudied. This research aimed to evaluate changes in conjunctival and nasal microflora in patients receiving topical cyclosporine for dry eye. Methods: In this cross-sectional study, conjunctival and nasal samples were collected from two groups of dry eye patients. Group 1 consisted of 38 patients using CsA eye drops, while Group 2 included 34 patients using preservative-free artificial tear drops. Bacterial cultures were grown from the samples, and the identified organisms underwent antibiotic susceptibility testing. Additionally, alpha diversity metrics were employed to assess the diversity of bacterial species in the samples. Results: Bacterial growth was observed in 75% of conjunctival samples and 97.22% of nasal samples. Staphylococcus epidermidis was the predominant organism in both groups. Alpha diversity analysis showed no significant differences in Shannon diversity and OTU richness between the groups for most bacterial species. Antibiotic susceptibility tests revealed no substantial variations in resistance patterns between the groups. Conclusion: This study provides valuable insights into the impact of CsA eye drops on conjunctival and nasal flora in dry eye patients. The findings suggest that CsA does not significantly influence the composition, diversity, or antibiotic resistance patterns of ocular flora. Long-term topical cyclosporine treatment for dry eye does not significantly impact conjunctival microflora or lead to antibiotic resistance. These results have important implications for the safe use of CsA in patients undergoing ocular treatments, particularly those at risk of intraocular infections.

Determination of the qualitative composition of gingival microflora in patients with cementum caries, and periodontopathogens

The qualitative composition of the microflora of periodontal pockets and gingival fluid, the composition of periodontopathogens determined by the polymerase chain reaction (PCR) method, the main associations of microorganisms, parocementum caries, dental index were comparatively studiedin patients with external pathological resorption and patients from the comparison group.40 patients were selected for the study, 14 of them with cementum caries, 12 with external pathological root resorption, and 14 without damage to the root of the tooth were in the comparison group. According to the study, all patients with cementum caries and external pathological resorption had pathological processes in the periodontium. According to the results of the microbiological examination in different clinical conditions of the oral cavity, especially with different forms of damage to the periodontum and hard tissues of the teeth, the predominant microbial samples were studied.The study of the qualitative composition of the microflora revealed that the most common pathogens in patients with cementum caries were: Prevotellaintermedia, Tannerella forsythia, Porphyromonas gingivalis, Candida albicans, Treponemadenticola. In patients with external resorption, P. intermedia, Tr. denticola, C. albicans, T. forsythia, P. gingivalis Epstein-Barr viruses were found. These are periodontopathogenic microorganisms and have wide pathogenic properties.

Experience of inulin use for correcting intestinal microbiota in patients suffering from recurrent vulvovaginal candidiasis: A prospective cohort comparative study

Aim. To evaluate the effectiveness of inulin for the adjustment of intestinal microflora in patients with recurrent vulvovaginal candidiasis (VVC).
 Materials and methods. A prospective cohort comparative study included 79 women aged 18 to 50 years. They were divided into three groups: the main group included 32 patients receiving complex treatment with a dietary supplement containing inulin derived from the "Extra" variety of Jerusalem artichoke root in combination with fluconazole; the comparison group included 27 patients receiving fluconazole only; and the control group included 20 healthy women. The patients were followed up for 12 months. Examination included stool culture for dysbiosis, complete blood count, urinalysis, blood chemistry (glucose, bilirubin, alanine aminotransferase, aspartate aminotransferase, total protein, urea, creatinine), examination of the vulva and vaginal mucosa, vaginal smear microscopy for microflora, Gram staining, real-time polymerase chain reaction for Mycoplasma hominis, Ureaplasma parvum, Trihomonas vaginalis, Chlamydia traсhomatis, Candida albicans. Subsequently, all subjects every three months underwent a bimanual examination, speculum examination of the cervical mucosa and vagina, Gram staining of vaginal mucosa and cervix swabs, a thorough interview, and history taking. At 12 months, stool was cultured for dysbiosis again, and the data were analyzed.
 Results. The VVC therapy in the group of inulin-containing dietary supplement was more effective: the recurrence rate was 3 times lower than with the standard treatment regimen.
 Conclusion. The use of dietary supplement containing inulin derived from the "Extra" variety of Jerusalem artichoke root in complex therapy for recurrent VVC can significantly improve the gut and vagina microflora condition and prevent the recurrence and normalization of stool in patients.

СТРУКТУРА И ДИНАМИКА ИЗМЕНЕНИЯ МИКРОФЛОРЫ ГНОЙНЫХ ЗАБОЛЕВАНИЙ МЯГКИХ ТКАНЕЙ У ПАЦИЕНТОВ ОТДЕЛЕНИЙ ХИРУРГИЧЕСКОГО ПРОФИЛЯ В СОВРЕМЕННЫХ УСЛОВИЯХ

Background. To develop effective means of combating pathogenic microflora, as well as effective etiotropic treatment it is necessary to know the structure and emerging trends of surgical infection pathogens. Aim of the research – assessment of the structure and current dynamics of changes in the microbiological spectrum of causative agents of purulent processes in soft tissues of surgical patients at the present time. Material and methods. The results of microbiological cultures taken in the departments: surgical, burn, traumatology № 3 and anesthesiology, resuscitation and intensive care of the Emergency hospital in Grodno from 2016 to 2022 were analyzed. The microbiological spectrum of purulent diseases of soft tissues was compared with the results of cultures of all microflora isolated from patients of the studied departments to identify existing trends in pathogenic microflora in the hospital. Results. Despite the fact that the pathogenic microflora isolated from surgical patients was very diverse, most often Staphylococcus aureus was cultured from Gram-positive microorganisms, and Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii and Proteus mirabilis were cultured from Gram-negative microorganisms. A fungus of the genus Candida (Candida spp.) was cultured in a small but practically stable ratio of about 1 %. At the same time, there are no significant changes in the structure of the circulation of the leading microflora in patients with purulent processes of soft tissues over the studied period of time. Conclusions. The structure of the cultured microbial flora of the studied surgical departments, as a whole, when compared with microbes isolated from patients with purulent processes of soft tissues is almost identical. There are no significant changes in its structure in these patients. The most significant cultured organisms were Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii and Proteus mirabilis.

Prospects for Improving the Microflora in Diseases of the Urinary Tract Encountered in Gynecological Practice

When determining the quantitative and qualitative composition of the vaginal microflora in patients with chronic diseases, including infectious diseases, the state of vaginal dysbiosis was revealed. This condition complicates the course of the underlying disease, lengthens the duration of treatment, and causes inflammatory complications. Thus, women with chronic infectious pathologies have a state of dysbiosis in the vaginal microbiocenosis, changes in this state lead to a decrease in their own microflora relative to the norm and, as a consequence, an increase in the percentage of opportunistic pathogens and a quantitative increase. This leads to a further exacerbation of inflammatory processes in the affected genitals of patients under the influence of other conditionally pathogenic microorganisms and negatively affects the effectiveness of therapeutic processes as secondary complications.

The role of probiotics in current algorithms for the treatment of irritable bowel syndrome: A review

Irritable bowel syndrome (IBS) is a widespread disease that affects working-age people and significantly reduces their quality of life. Many experts have suggested that the colon microflora in patients with IBS is characterized by dysbiosis, which leads to increased fermentation, excessive gas formation, and symptoms typical of the disease. Currently, alterations of the intestinal microbiota are considered one of the main mechanisms of IBS development, which warrants the use of probiotics with proven effectiveness as a part of the complex therapy. Certain probiotic strains (including Bifidobacterium longum 35624 and Saccharomyces boulardii CNCM I-745) have been shown to be effective in normalizing stool frequency and consistency in IBS patients, regressing abdominal pain, and normalizing quality of life.

Mixed bacterial-viral lung infections in patients with cystic fibrosis

The main cause of death in patients with cystic fibrosis (CF) is infectious process in the lungs, in particular, chronic lung infections caused by various pathogens, most often a combination of bacteria, fungi, or viruses. Data on mixed bacterial and viral-bacterial infections from domestic and foreign sources are fragmentary and sparse. The dominant associations of bacterial and viral pathogens in patients with cystic fibrosis have not been studied properly, and data on their epidemiological significance are lacking. The aim of this study was to assess the prevalence of bacterial and viral infections in patients with cystic fibrosis and to substantiate the need for the development of virological monitoring. Methods. Biomaterials from the respiratory tract of CF patients (409 children and 160 adults with CF) examined from 2006 to 2022 were used. The study was carried out using bacteriological methods, molecular genetic methods (RT-PCR) and MALDI-TOF mass-spectrometry. Results. Microflora of the respiratory tract was shown to be mixed in 2/3 patients with CF. The microflora of the lungs of children with CF is a dynamic community of microorganisms with high diversity and variability. In adult patients, associations of microorganisms are more common than in children, but the composition of associations is less diverse. We isolated about 40 species of bacteria from adult patients and more than 85 species from children in our sample. NFMO prevailed, including Burkholderia cepacia complex, Pseudomonas aeruginosa, Achromobacter xylosoxidans, Achromobacter ruhlandii, Stenotrophomonas maltophilia, and Staphylococcus aureus, Candida albicans, Aspergillus spp. Real-time PCR showed the presence of rhinovirus RNA in 10% of samples obtained from children and 12.9% from adults with cystic fibrosis. Conclusion. Our results indicate the need for continuous monitoring of the lung microflora in patients with CF, including testing for viruses.

Evaluation of the state of colonic microflora in patients with non-alcoholic fatty liver disease with immune response to SARS-CoV-2

Background. The prevalence of non-alcoholic fatty liver disease (NAFLD) is currently increasing worldwide and is a serious problem that causes interest in its study, especially in patients with an immune response to severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). In recent years, studies have been investigating the influence of microflora on the development and progression of NAFLD. The purpose of the study was to determine the level of dysbiotic disorders of the colonic microbiocenosis in patients with NAFLD with an immune response to SARS-CoV-2. Materials and methods. We examined 34 patients with NAFLD who were found to have IgG to SARS-CoV-2. All examined patients were divided into two groups: group I consisted of 17 patients with no history of SARS-CoV-2 according to the polymerase chain reaction (PCR) data; group II— 17 patients with a history of SARS-CoV-2 by PCR. The control group consisted of 10 practically healthy individuals. Chromatographic determination of the content of short-chain fatty acids, species and quantitative composition of the colonic microflora was performed. Results. The microbiological studies revealed changes in the qualitative and quantitative composition of the colonic microflora in 88.2% of patients with NAFLD, with a predominance of dysbiosis II in 41.2% of patients in group I and dysbiosis I in 70.6% of patients in group II. These changes were due to a decrease in the number of bifidobacteria and lactobacilli, an increase in the concentration of opportunistic pathogens, fungi of the genus Candida spp. The intestinal microbiome of patients with NAFLD who had SARS-CoV-2 showed impaired biosynthesis of short-chain fatty acids in the coprofiltrate, which was manifested by an increase in the median acetic and propionic acids and a decrease in the median butyric acid in patients of group I. The median anaerobic index had a statistically significant decrease in patients of group I by 1.5 times (p<0.05) and a tendency to a decrease in patients of group II. Significant intergroup differences were found for anaerobic index, its median was 1.4 times higher in group II (p<0.05) compared with group I. Conclusions. A decrease in the level of normoflora representatives, an increase in opportunistic pathogens, a tendency to a decrease in the concentration of butyric acid, an increase in acetic and propionic acids in the feces were found in patients with NAFLD who had SARS-CoV-2.

The importance of the genital tract microflora in the endometriosis development

Endometriosis is a common pathology among women of reproductive age. In the pathogenesis of its development a great importance is paid to the process of regulation of estrogens and other sex hormones, the implementation of the immune response at the general and local levels, the inflammatory response, and genetic background. In recent years, the role of the microbiota in different parts of the genital tract of the female organism has been studied not only from the standard approach of inflammatory diseases research of the reproductive organs and pathological vaginal discharge, but its contribution into the development of other gynecological diseases, in particular endometriosis, is presented.The article is devoted to a review of scientific publications about researches devoted to the significance of the genital tract microflora in the pathophysiology of endometriosis. The article presents the concepts of states of eubiosis and dysbiosis, describes the features of the microflora of the lower (vagina, cervix) and upper parts (uterus, fallopian tubes) of the genital tract in healthy women. The data on the importance of Lactobacillus in maintaining an optimal state of acidity in the vaginal environment are presented. The difference in the composition of the microbiota of the vagina, cervical mucus, uterine cavity and peritoneal fluid in women with and without endometriosis is revealed. The pathogenetic mechanisms of the role of the microbiota in the processes of endometriosis pathogenesis, namely, the regulation of the immune response and inflammation processes in this pathology, are described. It has been shown that in women with endometriosis there are differences in the microflora composition of the vagina, cervix, uterine cavity, peritoneal fluid, manifested by a decreased concentration of Lactobacillus and the presence of a variety of other microorganisms in relation to healthy women. The data about the role of gut microflora in patients with this pathology are also presented. The results of research about the diagnosis of various stages of endometriosis by studying the composition of the genital tract microbiota are described.

Fecal Immunoglobulin Levels as a Modifier of the Gut Microbiome in Patients with Common Variable Immunodeficiency

ObjectiveCommon variable immunodeficiency (CVID) is the most common clinically relevant entity of inborn errors of immunity. In these patients, an altered gut microbiome composition with reduced diversity has been described. We sought to investigate the fecal immunoglobulin levels and their impact on the gut microflora in patients with CVID.MethodsWe analyzed the gut microbiome of 28 CVID patients and 42 healthy donors (HDs), including 21 healthy household controls, by sequencing the V3 and V4 regions of the bacterial 16S rRNA gene extracted from stool samples. The fecal levels of immunoglobulin A, M, and G of 27 CVID patients and 41 HDs were measured in the supernatant by ELISA and normalized for protein concentration.ResultsWe measured decreased IgA and increased IgG in stool samples from CVID patients compared to HDs. Decreased levels of fecal IgA and IgM were associated with reduced microbial diversity and increased dysbiosis. We identified a large number of significantly differentially abundant taxa, especially in patients with decreased IgA levels, but also in patients with decreased IgM levels compared to their counterparts.ConclusionsCVID patients have an altered gut microbiota composition, which is most prevalent in patients with decreased fecal IgA and IgM levels. In this study, we identify fecal immunoglobulins as a potential modifier of the gut microbiome in CVID patients.

Analysis of Bacterial Pathogens Causing Complicating HAP in Patients with Secondary Peritonitis

Diffuse peritonitis is an acute abdominal condition characterized by high mortality. The main treatment modality is surgery, requiring a subsequent prolonged hospital stay. These patients are, among other things, at risk of developing hospital-acquired pneumonia (HAP), which considerably worsens their treatment outcomes. This study aimed to extend the existing knowledge by providing more detailed microbiological characteristics of complicating HAP in patients with secondary peritonitis, including the identification of isolated bacterial pathogens and their potential sources. The 2015-2019 retrospective study comprised all patients with an intraoperatively confirmed diagnosis of secondary diffuse peritonitis who were classified in accordance with the quick Sepsis Related Organ Failure Assessment scoring system. HAP developed in 15% of patients. The 90-day mortality rates were 53% and 24% in patients with and without HAP; respectively. The most frequent pathogens responsible for HAP were Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae complex and Enterococcus faecalis. Multidrug resistance to antibiotics was found in 38% of bacterial pathogens. Clonal spread of these bacterial pathogens among patients was not detected. Rather, the endogenous characteristic of HAP was confirmed. The initial antibiotic therapy of complicating HAP in patients with secondary peritonitis must be effective mainly against enterobacteria, including strains with the production of ESBL and AmpC beta-lactamases, Pseudomonas aeruginosa and Enterococcus faecalis. The study further highlighted the importance of monitoring the respiratory tract bacterial microflora in patients with secondary peritonitis. The results should be used for initial antibiotic treatment of complicating HAP instances.

Microbiota of the small intestine in patients with COVID-19

To date, the study of the relationship between the intestinal microbiome and COVID-19 infection remains a topical issue. As is known, the gastrointestinal tract is the entrance gate for SARS-CoV2 infection, and the prevalence of gastrointestinal manifestations reaches 17,6%. The conducted studies testify in favor of changes in the composition of the intestinal microflora in patients with COVID-19 compared with patients without a respiratory infection, their influence on the course and prognosis of the disease is being studied.

Probiotics and hepatoprotectors in the treatment of acute viral hepatitis

Relevance. In patients with acute viral hepatitis A and B, favorable conditions are created for the development of dysbiotic changes. As a result, the toxic load on the liver increases. For effective treatment of acute viral hepatitis A and B, the combined administration of probiotics and hepatoprotectors is necessary. Aim. To study the clinical course, the functional state of the liver, the intestinal microflora in patients with acute viral hepatitis A and B, and the effectasy of using a combination of probiotics and hepatoprotectors to correct the intestinal microflora. Materials and methods. The work used clinical and laboratory data of 74 patients with AVHA and AVHB. The main group of patients received complex therapy with probiotics and hepatoprotectors on the background of basic therapy. The comparison group patients were on conventional therapy. Clinical, biochemical, bacteriological parameters were observed before the start of therapy and 15 days later, serological markers - upon admission. Results. In patients with AVHA and AVHB of the main group, the main clinical manifestations disappeared significantly earlier than in the control group. Patients of the main group with AVHA after treatment had significantly lower values of ALT, total bilirubin, indirect bilirubin, cholesterol than in the control group. Patients with AVHB who received complex treatment, after its completion, had values of ALT, total, direct bilirubin and cholesterol significantly lower than control group. After the treatment in the main group, a significant increase in the total number of bifidobacteria was revealed, and in the main group, patients with AVHA after treatment showed a significant increase in the total number of E. coli. Conclusion. The use of combination therapy with probiotics and hepatoprotectors against the background of basic treatment in patients with acute viral hepatitis A and B has a positive effect on clinical parameters, the functional state of the liver and intestinal microbiocenosis.

Clinical efficacy of a modern probiotic for the correction of intestinal microflora in patients with irritable bowel syndrome with diarrhea and antibiotic-associated diarrhea

Despite the fact that dietary supplements (DS) are not medicines, an increasing number of publications testify to the effectiveness of probiotics consumed with food in the complex treatment and prevention of a number of diseases of the gastrointestinal tract, including irritable bowel syndrome (IBS) and antibiotic-associated diarrhea (AAD). The purpose of the study was to evaluate the effectiveness of the complex probiotic in the relief of diarrheal syndrome associated with intestinal microbiota dysbiosis in patients with IBS with diarrhea and AAD. Material and methods. The study included 54 patients (31 with IBS with diarrhea and 23 with idiopathic AAD) aged 18 to 50 years. All patients included in the study were prescribed 1 capsule (350 mg) of the DS Neobiotic Lactobalance® per day for 21 days. One capsule contains: bifidobacteria (Bifidobacterium longum CBT BG7, Bifidobacterium lactis CBT BL3 Bifidobacterium bifidum CBT BF3), lactobacilli (Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5), lactic acid bacteria (Streptococcus thermophilus CBT ST3), fructooligosaccharides, vitamin C. The daily intake of bifidobacteria was 8.7×108 CFU, lactobacilli - 6.1×109 CFU, lactic acid bacteria 3.1×108 CFU and vitamin C - 12 mg. The severity of symptoms was assessed in points (from 0 to 7 points) using the GSRS questionnaire (Gastrointestinal Symptom Rating Scale). All patients underwent a microbiological analysis of feces with an assessment of the degree of dysbiosis before and after the administration of DS. Results. In patients with IBS with diarrhea, the assessment of the manifestations of diarrheal syndrome according to the GSRS questionnaire decreased statistically significantly from 17 to 6 points (2.9 times), abdominal pain - from 12 to 4 points (3.0 times) and dyspeptic syndrome - from 8 to 3 points (in 2.7 times). In patients with AAD, also according to the GSRS questionnaire, the manifestations of diarrheal syndrome decreased statistically significantly from 13 to 3 points (4.3 times), abdominal pain - from 4 to 1 points (4.0 times) and dyspepsia syndrome - from 5 to 2 points (in 2.5 times). Against the background of DS intake, according to the data of bacteriological examination of feces, intestinal microbiota normalized by day 21 due to an increase in the number of lacto- and bifidobacteria (p=<0.05). Conclusion. The study showed that the DS Neobiotic Lactobalance® contributes to the normalization of the intestinal microbiota and reduces the severity of clinical manifestations (diarrheal disorders or manifestations of diarrhea) in IBS and idiopathic AAD.