title: An analysis of microbiota-targeted therapies in patients with avian influenza virus subtype H7N9 infection.
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.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Lu
authors.forename: Chunxia
authors.initials: C
authors.lastname: Zhang
authors.forename: Guirong
authors.initials: G
authors.lastname: Qian
authors.forename: Xinjun
authors.initials: X
authors.lastname: Hu
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.forename: Chunlei
authors.initials: C
authors.lastname: Chen
authors.forename: Weifeng
authors.initials: W
authors.lastname: Liang
authors.forename: Hainv
authors.initials: H
authors.lastname: Gao
authors.affiliation: 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. ymyang@zju.edu.cn.
authors.forename: Yunmei
authors.initials: Y
authors.lastname: Yang
authors.forename: Lanjuan
authors.initials: L
authors.lastname: Li
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001644:Bifidobacterium; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D007167:Immunotherapy; D064766:Influenza A Virus, H7N9 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019936:Probiotics / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents