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Open Access Highly Accessed Research article

An analysis of microbiota-targeted therapies in patients with avian influenza virus subtype H7N9 infection

Haifeng Lu12, Chunxia Zhang3, Guirong Qian12, Xinjun Hu12, Hua Zhang12, Chunlei Chen12, Weifeng Liang12, Hainv Gao12, Yunmei Yang3* and Lanjuan Li12*

Author Affiliations

1 State Key Laboratory Diagnosis and Treatment for Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China

2 Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China

3 Department of Geriatrics, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China

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BMC Infectious Diseases 2014, 14:359  doi:10.1186/1471-2334-14-359

Published: 2 July 2014

Abstract

Background

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. Our aim was to summarize the effectiveness of these therapies in re-establishing a stable and diverse microbial community, and reducing secondary infections.

Methods

Comprehensive 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.

Results

Different 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.

Conclusions

Elderly 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.

Keywords:
H7N9; Intestinal microbiota; Probiotics; Microbiota restoration treatment; Quantitative PCR