Analysis of the effect of combinations of Bacillus probiotic cultures on treatment outcomes in patients with combat trauma in the intensive care units

Abstract

Background. In recent years, spore-forming bacteria of the Ваcillus species, as the brightest representatives of exogenous microflora, have attracted the attention of researchers. One of the most studied probiotics with proven probiotic activity, high efficiency and safety are Bacillus, species of non-pathogenic spore-forming bacteria. The use of probiotic disinfection in medical institutions is a promising direction for the prevention of antibacterial polyresistance in the fight against nosocomial infection. The goal is to analyze the effectiveness of combinations of Bacillus probiotic cultures in the intensive care patients. Materials and methods. The basis of this study is the analysis of the results of a comprehensive clinical-instrumental and laboratory study of clinical, hemodynamic, biochemical indicators, as well as systemic inflammatory markers in 74 patients with combat trauma within day 1–10 of hospital stay, who were treated in the anesthesiology, resuscitation and intensive care unit and the emergency department of the Military Medical Clinical Center of the Northern Region from May 2022 to May 2023. Results. A statistical analysis of the correspondence of identified pathogens to the options of prescribing antibacterial drugs revealed a tendency to decrease in the number of different pathogens per 1 patient during the 10-day stay in the intensive care unit/emergency department. When carrying out a statistical analysis of the changes in intoxication indices, an increase of LII and LI was detected already on the day 1 of treatment; on the day 3 of the study, an upward trend for both studied indices was noted without statistical probability between the groups; оn day 5 of hospital stay in patients of groups I and II, the average LII and LI had a tendency to gradually increase, 11.4 ± 3.2 c.u. and 8.6 ± 1.1 c.u., 4.2 ± 1.7 c.u. and 3.9 ± 0.8 c.u., accordingly, without statistically probable changes due to the large dispersion of each of these indices in the variation series of indicators in patients of both groups; on the day 7 of the study, this trend persisted and these parameters were 10.7 ± 3.6 c.u. and 8.6 ± 1.1 c.u., 4.9 ± 1.2 c.u. and 3.6 ± 0.7 c.u. in patients of groups I and II, respectively; on the day 10 of observation, the average values of LII and LI almost equaled. It is important to determine a probable (p < 0.05) increase in the LII in patients of group I on the day 5 of treatment compared to the day 1: 11.4 ± 3.2 c.u. and 3.2 ± 0.7 c.u., respectively, and on the day 3: 11.4 ± 3.2 c.u. and 5.2 ± 1.1 c.u., respectively. This trend persisted until the day 7 of hospital stay, when the LII was probably (p < 0.05) higher than the index on the first day of observation: 10.7 ± 3.6 c.u. and 3.2 ± 0.7 c.u., respectively, and on the day 3 of intensive care: 10.7 ± 3.6 c.u. and 5.2 ± 1.1 c.u. The average length of stay in the intensive care unit in group I was 16.2 ± 9.6 days, in group II — 12.4 ± 8.9 days without a probable statistical difference between the groups due to the considerable dispersion of this indicator in the variation series among patients. Identical dynamics was determined when comparing the changes of the Sequential Organ Failure Assessment score. Conclusions. The use of combinations of Bacillus probiotic cultures in intensive care patients during 10 days of hospital stay against the background of the de-escalation principle of prescribing antibacterial drugs contributed to the reduction in the number of drugs with antibacterial properties in the treatment protocol.

Keywords

• combat trauma
• antibiotic resistance
• combinations of probiotic cultures
• intensive care unit