[Efficacy of Saccharomyces boulardii CNCM I-745 probiotic drug in the prevention and treatment of diarrhea in hospitalized patients with new coronavirus infection COVID-19].

AIM: To evaluate the efficacy of Saccharomyces boulardii (S. boulardii) CNCM I-745 probiotic drug in preventing and treating diarrhea in hospitalized patients with COVID-19. MATERIALS AND METHODS: A prospective comparative study was conducted in two parallel groups. The study included males and females aged 18 to 60 with the following diagnosis confirmed by polymerase chain reaction: U07.2 Coronavirus infection COVID-19, caused by SARS-CoV-2 virus (grade 1-3 pneumonia according to CT scan). All patients received antibiotic therapy. The patients were subdivided into two equal groups (n=60) depending on the administration of S. boulardii CNCM I-745 probiotic drug in addition to standard treatment. The probiotic was prescribed by the attending physician; the dose was 2 capsules per day (500 mg/day) 30 min before the meal for 10 days. All patients were monitored for main clinical, laboratory, and instrumental parameters during the study. In addition, the symptom of diarrhea (stool with a frequency of more than 3 times a day of type 6 and 7 according to the Bristol stool scale), including its frequency, duration, and the number of bowel movements of loose stool per day were precisely evaluated in both groups. RESULTS: In the overall patient pool, diarrhea was reported in 21.7% of in-patients during the observation period (95% confidence interval [CI] 14.2-29.1) with a mean duration of 4.6154 days (95% CI 3.7910-5.4398). The incidence of diarrhea in group 1 was 13.3% (95% CI 4.5-22.2), and in group 2, it was 30.0% (95% CI 18.1-41.9). Relative risk showed that the use of the S. boulardii CNCM I-745 probiotic drug leads to a significant reduction in the risk of diarrhea in hospitalized patients with COVID-19 infection receiving antibiotic therapy (odds ratio [OR] 0.3590, 95% CI 0.1421-0.9069; p=0.0303). In group 1, the duration of diarrhea was 3.1250 days (95% CI 2.5892-3.6608) versus 5.2778 days (95% CI 4.2290-6.3265) in group 2, p=0.0112. The mean daily frequency of loose stools in patients with diarrhea in group 1 was 3.2500 (95% CI 2.6588-3.8412) versus 4.3889 (95% CI 3.7252-5.0525) in group 2, p=0.0272. The secondary endpoint, duration of hospital stay, was also significantly shorter in group 1 patients - 11.6833 days (95% CI 11.2042-12.1625) versus 12.7333 days (95% CI 12.1357-13.3309) in group 2, p=0.0120. CONCLUSION: The present prospective comparative study demonstrated that adding S. boulardii CNCM I-745 probiotic drug into the standard treatment regimen of patients with new coronavirus infection COVID-19 receiving antibiotic therapy helps reduce the incidence of diarrhea and its severity during hospitalization, as well as the duration of hospital stay.

[Composition of oropharyngeal microbiota in patients with COVID-19 of different pneumonia severity].

AIM: To identify features of the taxonomic composition of the oropharyngeal microbiota of COVID-19 patients with different disease severity. MATERIALS AND METHODS: The study group included 156 patients hospitalized with confirmed diagnosis of COVID-19 in the clinical medical center of Yevdokimov Moscow State University of Medicine and Dentistry between April and June 2021. There were 77 patients with mild pneumonia according to CT (CT1) and 79 patients with moderate to severe pneumonia (CT2 and CT3). Oropharyngeal swabs were taken when the patient was admitted to the hospital. Total DNA was isolated from the samples, then V3V4 regions of the 16s rRNA gene were amplified, followed by sequencing using Illumina HiSeq 2500 platform. DADA2 algorithm was used to obtain amplicon sequence variants (ASV). RESULTS: When comparing the microbial composition of the oropharynx of the patients with different forms of pneumonia, we have identified ASVs associated with the development of both mild and severe pneumonia outside hospital treatment. Based on the results obtained, ASVs associated with a lower degree of lung damage belong predominantly to the class of Gram-negative Firmicutes (Negativicutes), to various classes of Proteobacteria, as well as to the order Fusobacteria. In turn, ASVs associated with a greater degree of lung damage belong predominantly to Gram-positive classes of Firmicutes Bacilli and Clostridia. While being hospitalized, patients with severe pneumonia demonstrated negative disease dynamics during treatment significantly more often. CONCLUSION: We have observed differences in the taxonomic composition of the oropharyngeal microbiota in patients with different forms of pneumonia developed outside hospital treatment against COVID-19. Such differences might be due to the presumed barrier function of the oropharyngeal microbiota, which reduces the risk of virus titer increase.

Evaluation of the efficacy and safety of remdesivir in hospitalized patients with a new coronavirus infection COVID-19: data from a Russian university clinic

Introduction. The use of remdesivir in patients with the new coronavirus infection COVID-19 is known to improve the prognosis of the disease. But there is not enough data on efficacy and safety of remdesivir use in patients from Russia. Aim. To evaluate the efficacy and safety of remdesivir in patients with COVID-19. Materials and methods. A comparative prospective study was conducted in two parallel groups. The study enrolled 300 patients diagnosed with COVID-19 (grade 1–3 severe pneumonia according to CT scan), who were divided into two groups (n = 150 in each) according to the prescription of remdesivir. Treatment efficacy was assessed by recording cases of disease progression and adverse outcomes. The safety of therapy was assessed by hepatotoxicity and nephrotoxicity. Results. Patients receiving remdesivir were significantly less likely to be transferred to the intensive care unit (OR 0.3884, 95% CI: 0.1645–0.9175) and to be on artificial ventilation (OR 0.3830, 95% CI: 0.1539–0.9527). Treatment with remdesivir had no significant effect on mortality (OR 0.4932, 95% CI: 0.08897–2.7346) and complications (OR 0.4391, 95% CI: 0.1623–1.1879), including acute respiratory distress syndrome (OR 0.3919, 95% CI: 0.07483–2.0524). The duration of hospitalization was significantly short-er in group 1 patients – 12.2533 days (95% CI: 11.4101–13.0966) compared to group 2 – 14.5267 days (95% CI: 13.5125–15.5408). Hepatotoxicity with remdesivir (OR 1.5376, 95% CI: 0.8035–2.9426), nephrotoxicity (OR 1.6338, 95% CI: 0.522–5.1141) were noted, but no statistically significant difference was found (p > 0.05). Conclusions. The addition of remdesivir to the basic regimen of patients with new coronavirus infection COVID-19 improved the course of the disease, reducing the risks of patients being transferred to the intensive care unit and of receiving artificial ventilation. © 2022, Remedium Group Ltd. All rights reserved.