Microbiota-Oriented Diagnostics and Therapy in Sepsis: Utopia or Necessity?

When diagnosing sepsis, it is common to look for pathogens, microbe’s DNA, lipopolysaccharide (LPS), or host biomarkers while missing out on microbiota. The next-generation sequencing of 16S rRNA gene allowed characterizing the gut microbiota taxonomy and clarifying the gut microbial population being more complex than was previously thought. We suppose that significant disruption of the microbiota is an indicator of the major role it plays in sepsis. Serious metabolic disorders of the gut microbiota may contribute to an unfavorable outcome in septic patients. With the changes not only in the composition but also in the metabolic activity of the gut microbiota taken into account, the characteristics of the mechanisms of interactions in the “septic” microbiome will allow the advances in the optimization of the diagnostics and therapy of sepsis to be made

The role of human and microbial metabolites of triptophane in severe diseases and critical ill (review)

The growing interest to metabolites circulating in the blood is associated with the accumulation of factual material on the involvement of low-molecular compounds in the development of a number of serious diseases. This review reveals the effect of a whole class of chemical compounds tryptophan metabolites on various pathological processes. The following keywords were used to find the publications in the PubMed database for the last 10 years: names of natural indole compounds, methods for their detection, nosology of diseases and critical illness . The data are presented in sections, with the studies of tryptophan metabolites in a variety of disease groups, such as cancer, cardiovascular disease, kidney disease, bowel, mental disorders, atherosclerosis, etc. A particular attention is paid to the role of indole compounds that enter the systemic circulation as a result of microbial biotransformation of tryptophan, serotonin and other indole metabolites, which can be attributed to the common metabolites of humans and microbiota. The most interesting clinical studies are summarized in the tables and figures. A number of indole metabolites are considered as potential biomarkers. The authors of the review substantiate the metabolomic approach to the study of a number of oncological, septic, mental and other intractable diseases, which opens up new possibilities of influence on the pathological process by targeted regulation in the metabolome/microbiome system

Диагностическая значимость белка S100B при критических состояниях

The review deals with possibilities for the quantitative assessment of the degree of brain injury, by measuring the level of S100B protein in various biological fluids. Data are given on changes in the concentration of this protein in different categories of patients, including those who are critically ill. Key words: S100B protein, laboratory diagnosis of critical conditions, biomarkers, perinatal brain lesions.Обзор посвящен возможности количественной оценки степени повреждений мозга путем измерения уровня белка S100B в различных биологических жидкостях. Приводятся данные по изменению концентрации данного протеина у разных категорий больных, в том числе — находящихся в критическом состоянии. Ключевые слова: S100B, лабораторная диагностика критических состояний, биомаркеры, перинатальные повреждения головного мозга

Адаптивная фаготерапия пациентов с рецидивирующими пневмониями (пилотное исследование)

Aim. To evaluate the safety and efficacy of the adaptive phage therapy technique in patients with recurrent pneumonia in neurological critical care.Material and methods. The clinical study included 83 chronically critically ill patients with severe brain damage. The bacteriophage cocktail selected against specific hospital strains was administered by inhalation to 43 patients. The control group included 40 patients who received conventional antimicrobial therapy. The changes in clinical, laboratory and instrumental parameters, levels of biomarkers, microbiological and PCR tests of bronchoalveolar lavage fluid were assessed, including those in the «phage therapy with antibiotics» (n=29) and «phage therapy without antibiotics» (n=14) subgroups.Results. The groups were comparable in terms of basic parameters (age, sex, diagnosis, organ dysfunction according to APACHE II, use of vasoactive drugs) and the level of airway colonization with antibioticresistant bacterial strains. Good tolerability and absence of clinically significant side effects were observed during inhaled administration of the bacteriophage cocktail. Computed tomography on day 21 showed a significant reduction in lung damage in patients who received bacteriophages. Patients treated with bacteriophages without antibiotics had significantly lower need for mechanical ventilation. The mortality rate on day 28 did not differ significantly and was 4.7% (2/43) in the bacteriophage-treated group vs 5% (2/40) in the control group.Conclusion. The first experience of using the adaptive phage therapy technique in chronically critically ill patients in neurological intensive care demonstrated the safety of inhalational administration of the bacteriophage cocktail. The efficacy of the technique was confirmed by the treatment results obtained in the phage therapy group, which were not inferior to those in the group with conventional antibiotic therapy, while several clinical and laboratory parameters tended to improve even in patients who received bacteriophages and did not receive antibiotics.Цель. Оценка безопасности и эффективности технологии адаптивной фаготерапии в лечении пациентов с рецидивирующими пневмониями в нейрореаниматологии.Материал и методы. В клиническое исследование включили 83 пациента в хроническом критическом состоянии с тяжелым повреждением головного мозга. У 43 пациентов ингаляционно применили комплексный препарат бактериофагов, адаптированный к госпитальным штаммам данного учреждения. Группу сравнения сравнения составили пациенты (n=40), получавшие традиционную антибактериальную терапию. Оценивали динамику клинико-лабораторных, инструментальных показателей, биомаркеров, результаты микробиологических и ПЦР-исследований бронхо-альвеолярного лаважа, в том числе — раздельно в подгруппах «фаготерапия с антибиотиками» (n=29) и «фаготерапия без антибиотиков» (n=14).Результаты. Группы были сопоставимы по основным показателям (возраст, пол, диагноз, степень органных дисфункций по APACHE II, применение вазоактивных препаратов) и уровню бактериальной колонизации дыхательных путей антибиотикорезистентными штаммами. При ингаляционном введении комплексного препарата бактериофагов наблюдали хорошую переносимость, отсутствие клинически значимых побочных эффектов. По данным компьютерной томографии, к 21-му дню выявили значимое снижение степени повреждения легких. У пациентов, получавших лечение бактериофагами без антибиотиков, значимо снизилась потребность в проведении искусственной вентиляции легких. Летальность к 28-м сут. значимо не различалась: при фаготерапии — 2/43 (4,7%), в группе сравнения — 2/40 (5%).Заключение. Первый опыт применения технологии адаптивной фаготерапии в лечении хронических реанимационных пациентов в нейрореаниматологии продемонстрировал безопасность ингаляционного введения комплексного препарата бактериофагов. Эффективность технологии подтверждена результатами лечения, полученными в группе фаготерапии, которые не уступали таковым в группе с традиционной антибиотикотерапией, а ряд клинико-лабораторных показателей имел тенденцию к улучшению даже в случаях полного отказа от антибиотиков в пользу бактериофагов

Adaptive Phage Therapy in the Treatment of Patients with Recurrent Pneumonia (Pilot Study)

Aim. To evaluate the safety and efficacy of the adaptive phage therapy technique in patients with recurrent pneumonia in neurological critical care.Material and methods. The clinical study included 83 chronically critically ill patients with severe brain damage. The bacteriophage cocktail selected against specific hospital strains was administered by inhalation to 43 patients. The control group included 40 patients who received conventional antimicrobial therapy. The changes in clinical, laboratory and instrumental parameters, levels of biomarkers, microbiological and PCR tests of bronchoalveolar lavage fluid were assessed, including those in the «phage therapy with antibiotics» (n=29) and «phage therapy without antibiotics» (n=14) subgroups.Results. The groups were comparable in terms of basic parameters (age, sex, diagnosis, organ dysfunction according to APACHE II, use of vasoactive drugs) and the level of airway colonization with antibioticresistant bacterial strains. Good tolerability and absence of clinically significant side effects were observed during inhaled administration of the bacteriophage cocktail. Computed tomography on day 21 showed a significant reduction in lung damage in patients who received bacteriophages. Patients treated with bacteriophages without antibiotics had significantly lower need for mechanical ventilation. The mortality rate on day 28 did not differ significantly and was 4.7% (2/43) in the bacteriophage-treated group vs 5% (2/40) in the control group.Conclusion. The first experience of using the adaptive phage therapy technique in chronically critically ill patients in neurological intensive care demonstrated the safety of inhalational administration of the bacteriophage cocktail. The efficacy of the technique was confirmed by the treatment results obtained in the phage therapy group, which were not inferior to those in the group with conventional antibiotic therapy, while several clinical and laboratory parameters tended to improve even in patients who received bacteriophages and did not receive antibiotics

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]