medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2020-37-16-20medalphabet-1861Research ArticleСтатьиМикробиота кишечника и критические состоянияIntestinal microbiota and critical conditionsАхмедовВ. А.AkhmedovV. A.

д. м. н., проф., зав. кафедрой медицинский реабилитации ДПО

г. Омск

Omsk

КашеваК. А.KashevaK. A.

студентка VI курса лечебного факультета

г. Омск

Omsk

ГаусО. В.GausO. V.

к. м. н., доцент кафедры факультетской терапии и гастроэнтерологии

г. Омск

Omsk

ФГБОУ ВО «Омский государственный медицинский университет» Минздрава РоссииРоссияOmsk State Medical UniversityRussian Federation202015012021037Практическая гастроэнтерология (4)1620Copyright © Ахмедов В.А., Кашева К.А., Гаус О.В., 20212021Ахмедов В.А., Кашева К.А., Гаус О.В.Akhmedov V.A., Kasheva K.A., Gaus O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1861

Кардинальная трансформация микробиоты кишечника по составу, количеству и продуктам метаболизма негативно влияет на эффективность терапии пациентов с крайней степенью тяжести заболевания. Нарушение функций кишечной микробиоты является прогностическим параметром и одной из основных причин возникновения осложнений, присоединения инфекций и развития сепсиса. В настоящее время используются шкалы, оценивающие состояние и прогноз больных, однако микробиота не входит в этот перечень исследуемых показателей. В последние 10 лет стало возможным более подробно изучить и охарактеризовать микроорганизмы кишечника. В настоящем обзоре приведены анализ литературы о значении бактерий кишечника у пациентов с крайней степенью тяжести заболевания, сведения о возможных осложнениях и лечении нарушений, связанных с дисфункцией кишечной микробиоты.

The cardinal transformation of the intestinal microbiota in composition, quantity and metabolic products negatively affects the effectiveness of therapy in patients with extreme severity of the disease. Dysfunction of the intestinal microbiota is a prognostic parameter and one of the main causes of complications, infections and the development of sepsis. Currently, scales are used that assess the condition and prognosis of patients, but the microbiota is not included in this list of the studied parameters. In the last 10 years, it has become possible to study andcharacterize intestinal microorganisms in more detail. This review provides an analysis of the literature on the importance of intestinal bacteria in patients with extreme severity of the disease, information on possible complications and treatment of disorders associated with dysfunction of the intestinal microbiota.

микробиотапациенты с крайней степенью тяжести заболеванийкритическое состояниереанимация и интенсивная терапияинфекционные осложненияmicrobiotapatients with extreme severity of diseasescritical conditionresuscitation and intensive careinfectious complicationsReferencesJandhyala S. M., Talukdar R., Subramanyam C., Vuyyuru H., Sasikala M., Reddy D. N. Role of the normal gut microbiota. World J Gastroenterol. 2015. Vol. 21, No. 29. P. 8787–8803.Jandhyala S. M., Talukdar R., Subramanyam C., Vuyyuru H., Sasikala M., Reddy D. N. Role of the normal gut microbiota. World J Gastroenterol. 2015. Vol. 21, No. 29. P. 8787–8803.Ивашкин В. Т., Ивашкин К. В. Микробиом человека в приложении к клинической практике. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2017. Т. 27, № 6. С. 4–13.Ивашкин В. Т., Ивашкин К. В. Микробиом человека в приложении к клинической практике. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2017. Т. 27, № 6. С. 4–13.Гаус О. В., Ливзан М. А. Синдром раздраженного кишечника: что мы знаем о симптомах сегодня? Consilium Medicum. 2019. Т. 21, № 8. С. 42–49.Гаус О. В., Ливзан М. А. Синдром раздраженного кишечника: что мы знаем о симптомах сегодня? Consilium Medicum. 2019. Т. 21, № 8. С. 42–49.Ахмедов В. А., Гаус О. В. Роль кишечной микробиоты в формировании неалкогольной жировой болезни печени. Терапевтический архив. 2019. Т. 91, № 2. С. 143–148.Ахмедов В. А., Гаус О. В. Роль кишечной микробиоты в формировании неалкогольной жировой болезни печени. Терапевтический архив. 2019. Т. 91, № 2. С. 143–148.Brenner T., Decker S. O., Grumaz S., Stevens P., Bruckner T., Schmoch T. et al. TIF Onet Critical Care Trials Group. Next-generation sequencing diagnostics of bacteremia in sepsis (Next GeneSiS-Trial): study protocol of a prospective, observational, non-interventional, multicenter, clinical trial. Medicine (Baltimore). 2018. Vol. 97, No. 6. e9868.Brenner T., Decker S. O., Grumaz S., Stevens P., Bruckner T., Schmoch T. et al. TIF Onet Critical Care Trials Group. Next-generation sequencing diagnostics of bacteremia in sepsis (Next GeneSiS-Trial): study protocol of a prospective, observational, non-interventional, multicenter, clinical trial. Medicine (Baltimore). 2018. Vol. 97, No. 6. e9868.Buffie C. G., Jarchum I., Equinda M., Lipuma L., Gobourne A., Viale A. et al. Profound alterations of intestinal microbiota following a single dose of clindamycin results in sustained susceptibility to Clostridium difficile-induced colitis. Infect. Immun. 2012. Vol. 80, No. 1. Р. 62–73.Buffie C. G., Jarchum I., Equinda M., Lipuma L., Gobourne A., Viale A. et al. Profound alterations of intestinal microbiota following a single dose of clindamycin results in sustained susceptibility to Clostridium difficile-induced colitis. Infect. Immun. 2012. Vol. 80, No. 1. Р. 62–73.Chaudhry N., Duggal A. K. Sepsis associated encephalopathy. Adv. Med. 2014. Vol. 2014. 762320 p.Chaudhry N., Duggal A. K. Sepsis associated encephalopathy. Adv. Med. 2014. Vol. 2014. 762320 p.Lepage P., Leclerc M. C., Joossens M., Mondot S., Blottière H. M., Raes J. et al. A metagenomic insight into our gut’s microbiome. Gut. 2013. Vol. 62, No. 1. P. 146–158.Lepage P., Leclerc M. C., Joossens M., Mondot S., Blottière H. M., Raes J. et al. A metagenomic insight into our gut’s microbiome. Gut. 2013. Vol. 62, No. 1. P. 146–158.Manzanares W., Lemieux M., Langlois P. L., Wischmeyer P. E. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit. Care. 2016. No. 19. 262 p.Manzanares W., Lemieux M., Langlois P. L., Wischmeyer P. E. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit. Care. 2016. No. 19. 262 p.McClave S.A., Patel J., Bhutiani N. Should fecal microbial transplantation be used in the ICU? Curr. Opin. Crit. Care. 2018. Vol. 24, No. 2. Р. 105–111.McClave S.A., Patel J., Bhutiani N. Should fecal microbial transplantation be used in the ICU? Curr. Opin. Crit. Care. 2018. Vol. 24, No. 2. Р. 105–111.Panigrahi P., Chandel D. S., Hansen N. I., Sharma N., Kandefer S., Parida S. et al. Neonatal sepsis in rural India: timing, microbiology and antibiotic resistance in a population-based prospective study in the community setting. J. Perinatol. 2017. Vol. 37, No. 8. P. 911–921.Panigrahi P., Chandel D. S., Hansen N. I., Sharma N., Kandefer S., Parida S. et al. Neonatal sepsis in rural India: timing, microbiology and antibiotic resistance in a population-based prospective study in the community setting. J. Perinatol. 2017. Vol. 37, No. 8. P. 911–921.Ojima M., Motooka D., Shimizu K., Gotoh K., Shintani A., Yoshiya K. et al. Metagenomic analysis reveals dynamic changes of whole gut microbiota in the acute phase of intensive care unit patients. Dig. Dis. Sci. 2016. Vol. 61, No. 6. P. 1628–1634.Ojima M., Motooka D., Shimizu K., Gotoh K., Shintani A., Yoshiya K. et al. Metagenomic analysis reveals dynamic changes of whole gut microbiota in the acute phase of intensive care unit patients. Dig. Dis. Sci. 2016. Vol. 61, No. 6. P. 1628–1634.Price R., MacLennan G., Glen J., SuDDICU Collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ. 2014. No. 348. g2197.Price R., MacLennan G., Glen J., SuDDICU Collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ. 2014. No. 348. g2197.Rogers A. J., McGeachie M., Baron R. M., Gazourian L., Haspel J. A., Nakahira K. et al. Metabolomic derangements are associated with mortality in critically ill adult patients. PLoS One. 2014. Vol. 9, No. 1. e87538.Rogers A. J., McGeachie M., Baron R. M., Gazourian L., Haspel J. A., Nakahira K. et al. Metabolomic derangements are associated with mortality in critically ill adult patients. PLoS One. 2014. Vol. 9, No. 1. e87538.Schmidt K., Mwaigwisya S., Crossman L. C., Doumith M., Munroe D., Pires C. et al. Identification of bacterial pathogens and antimicrobial resistance directly from clinical urines by nanopore-based metagenomic sequencing. J. Antimicrob. Chemother. 2017. Vol. 72, No. 1. P. 104–114.Schmidt K., Mwaigwisya S., Crossman L. C., Doumith M., Munroe D., Pires C. et al. Identification of bacterial pathogens and antimicrobial resistance directly from clinical urines by nanopore-based metagenomic sequencing. J. Antimicrob. Chemother. 2017. Vol. 72, No. 1. P. 104–114.Sekirov I., Russell S. L., Antunes L. C., Finlay B. B. Gut microbiota in health and disease. Physiol. Rev. 2010. Vol. 90, No. 3. Р. 859–904.Sekirov I., Russell S. L., Antunes L. C., Finlay B. B. Gut microbiota in health and disease. Physiol. Rev. 2010. Vol. 90, No. 3. Р. 859–904.Singh V., Roth S., Llovera G., Sadler R., Garzetti D., Stecher B. et al. Microbiota dysbiosis controls the neuroinflammatory response after stroke. J. Neurosci. 2016. Vol. 36, No. 28. Р. 7428–7440.Singh V., Roth S., Llovera G., Sadler R., Garzetti D., Stecher B. et al. Microbiota dysbiosis controls the neuroinflammatory response after stroke. J. Neurosci. 2016. Vol. 36, No. 28. Р. 7428–7440.Rogler G., Rosano G. The heart and the gut. Eur. Heart J. 2014. Vol. 35, № 7. Р. 426–430.Rogler G., Rosano G. The heart and the gut. Eur. Heart J. 2014. Vol. 35, № 7. Р. 426–430.Thorburn A. N., Macia L., Mackay C. R. Diet, metabolites, and western lifestyle inflammatory diseases. Immunity. 2014; 40 (6): 833–842. DOI: 10.1016/j. immuni.2014.05.014. PMID: 24950203.Thorburn A. N., Macia L., Mackay C. R. Diet, metabolites, and western lifestyle inflammatory diseases. Immunity. 2014; 40 (6): 833–842. DOI: 10.1016/j. immuni.2014.05.014. PMID: 24950203.Turnbaugh P. J., Hamady M., Yatsunenko T., Cantarel B. L., Duncan A., Ley R. E. et al. A core gut microbiome in obese and lean twins. Nature. 2009. Vol. 457, No. 7228. Р. 480–484.Turnbaugh P. J., Hamady M., Yatsunenko T., Cantarel B. L., Duncan A., Ley R. E. et al. A core gut microbiome in obese and lean twins. Nature. 2009. Vol. 457, No. 7228. Р. 480–484.van Nood E., Speelman P., Nieuwdorp M., Keller J. Fecal microbiota transplantation: facts and controversies. Curr. Opin. Gastroenterol. 2014. Vol. 30, No. 1. Р. 34–39.van Nood E., Speelman P., Nieuwdorp M., Keller J. Fecal microbiota transplantation: facts and controversies. Curr. Opin. Gastroenterol. 2014. Vol. 30, No. 1. Р. 34–39.Vincent J. L., Rello J., Marshall J., Silva E., Anzueto A., Martin C. D. et al. EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009. Vol. 302, No. 21. Р. 2323–2329.Vincent J. L., Rello J., Marshall J., Silva E., Anzueto A., Martin C. D. et al. EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009. Vol. 302, No. 21. Р. 2323–2329.Wischmeyer P. E., McDonald D., Knight R. Role of the microbiome, probiotics, and “dysbiosis therapy” in critical illness. Curr. Opin. Crit. Care. 2016. Vol. 22, No. 4. Р. 347–353.Wischmeyer P. E., McDonald D., Knight R. Role of the microbiome, probiotics, and “dysbiosis therapy” in critical illness. Curr. Opin. Crit. Care. 2016. Vol. 22, No. 4. Р. 347–353.Zaborin A., Smith D., Garfield K., Quensen J., Shakhsheer B., Kade M. et al. Membership and behavior of ultra-low-diversity pathogen communities present in the gut of humans during prolonged critical illness. MBio. 2014. Vol. 5, No. 5. e01361–14.Zaborin A., Smith D., Garfield K., Quensen J., Shakhsheer B., Kade M. et al. Membership and behavior of ultra-low-diversity pathogen communities present in the gut of humans during prolonged critical illness. MBio. 2014. Vol. 5, No. 5. e01361–14.Bongaerts G. P., Severijnen R. S. A reassessment of the PROPATRIA study and its implications for probiotic therapy. Nat. Biotechnol. 2016. Vol. 34, No. 1. P. 55–63.Bongaerts G. P., Severijnen R. S. A reassessment of the PROPATRIA study and its implications for probiotic therapy. Nat. Biotechnol. 2016. Vol. 34, No. 1. P. 55–63.Braniste V., Asmakh M., Kowal C., Anuar F., Abbaspour A., Tóth M. et al. The gut microbiota influences blood-brain barrier permeability in mice. Sci. Transl. Med. 2014. Vol. 263, No. 6. 158 p.Braniste V., Asmakh M., Kowal C., Anuar F., Abbaspour A., Tóth M. et al. The gut microbiota influences blood-brain barrier permeability in mice. Sci. Transl. Med. 2014. Vol. 263, No. 6. 158 p.Bravo J. A., Forsythe P., Chew M. V., Escaravage E., Savignac H. M., Dinan T. G. et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc. Natl. Acad. Sci. USA. 2011. Vol. 108, No. 38. P. 16050–16055.Bravo J. A., Forsythe P., Chew M. V., Escaravage E., Savignac H. M., Dinan T. G. et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc. Natl. Acad. Sci. USA. 2011. Vol. 108, No. 38. P. 16050–16055.Buelow E., Bello González T. D.J., Fuentes S., de Steenhuijsen Piters W. A.A., Lahti L., Bayjanov J. R. et al. Comparative gut microbiota and resistome profiling of intensive care patients receiving selective digestive tract decontamination and healthy subjects. Microbiome. 2017. Vol. 5, No. 1. 88 р.Buelow E., Bello González T. D.J., Fuentes S., de Steenhuijsen Piters W. A.A., Lahti L., Bayjanov J. R. et al. Comparative gut microbiota and resistome profiling of intensive care patients receiving selective digestive tract decontamination and healthy subjects. Microbiome. 2017. Vol. 5, No. 1. 88 р.Cho I., Blaser M. J. The human microbiome: at the interface of health and disease. Nat. Rev. Genet. 2012. Vol. 13, No. 4. Р. 260–270.Cho I., Blaser M. J. The human microbiome: at the interface of health and disease. Nat. Rev. Genet. 2012. Vol. 13, No. 4. Р. 260–270.Белобородова Н. В., Острова И. В. Сепсис-ассоциированная энцефалопатия (обзор). Общая реаниматология. 2017. Т. 13, No. 5. С. 121–139.Белобородова Н. В., Острова И. В. Сепсис-ассоциированная энцефалопатия (обзор). Общая реаниматология. 2017. Т. 13, No. 5. С. 121–139.Dethlefsen L., Relman D. A. Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation. Proc. Natl. Acad. Sci. USA. 2011. Vol. 108, Suppl 1. P. 4554–4561.Dethlefsen L., Relman D. A. Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation. Proc. Natl. Acad. Sci. USA. 2011. Vol. 108, Suppl 1. P. 4554–4561.Dickson R. P. The microbiome and critical illness. Lancet Respir. Med. 2016. Vol. 4, No. 1. Р. 59–72.Dickson R. P. The microbiome and critical illness. Lancet Respir. Med. 2016. Vol. 4, No. 1. Р. 59–72.Dickson R. P., Singer B. H., Newstead M. W., Falkowski N. R., Erb-Downward J.R., Standiford T. J. et al. Enrichment of the lung microbiome with gut bacteria in sepsis and the acute respiratory distress syndrome. Nat. Microbiol. 2016. Vol. 10, No. 1. 16113 р.Dickson R. P., Singer B. H., Newstead M. W., Falkowski N. R., Erb-Downward J.R., Standiford T. J. et al. Enrichment of the lung microbiome with gut bacteria in sepsis and the acute respiratory distress syndrome. Nat. Microbiol. 2016. Vol. 10, No. 1. 16113 р.Fedotcheva N. I., Chernevskaya E. A., Beloborodova N. V. The role of bacterial phenolic metabolites in mitochondrial dysfunction. Crit. Care. 2016. Vol. 20, Suppl 1. P 4.Fedotcheva N. I., Chernevskaya E. A., Beloborodova N. V. The role of bacterial phenolic metabolites in mitochondrial dysfunction. Crit. Care. 2016. Vol. 20, Suppl 1. P 4.Foster J. A., McVey Neufeld K. A. Gut-brain axis: how the microbiome influences anxiety and depression. Trends Neurosci. 2013. Vol. 36, No. 5. Р. 305–312.Foster J. A., McVey Neufeld K. A. Gut-brain axis: how the microbiome influences anxiety and depression. Trends Neurosci. 2013. Vol. 36, No. 5. Р. 305–312.Franzosa E. A., Huang K., Meadow J. F., Gevers D., Lemon K. P., Bohannan B. J. et al. Identifying personal microbiomes using metagenomic codes. Proc. Natl. Acad. Sci. USA.2015. Vol. 112, No. 22. E 2930–E 2938.Franzosa E. A., Huang K., Meadow J. F., Gevers D., Lemon K. P., Bohannan B. J. et al. Identifying personal microbiomes using metagenomic codes. Proc. Natl. Acad. Sci. USA.2015. Vol. 112, No. 22. E 2930–E 2938.Lam V., Su J., Hsu A., Gross G. J., Salzman N. H., Baker J. E. Intestinal microbial metabolites are linked to severity of myocardial infarction in rats. PLoS One. 2016. Vol. 11, No. 8. e0160840.Lam V., Su J., Hsu A., Gross G. J., Salzman N. H., Baker J. E. Intestinal microbial metabolites are linked to severity of myocardial infarction in rats. PLoS One. 2016. Vol. 11, No. 8. e0160840.Fung T. C., Olson C. A., Hsiao E. Y. Interactions between the microbiota, immune and nervous systems in health and disease. Nat. Neurosci. 2017. Vol. 20, No. 2. Р. 145–155.Fung T. C., Olson C. A., Hsiao E. Y. Interactions between the microbiota, immune and nervous systems in health and disease. Nat. Neurosci. 2017. Vol. 20, No. 2. Р. 145–155.Haak B. W., Levi M., Wiersinga W. J. Microbiota-targeted therapies on the intensive care unit. Curr. Opin. Crit. Care. 2017. Vol. 23, No. 2. Р. 167–174.Haak B. W., Levi M., Wiersinga W. J. Microbiota-targeted therapies on the intensive care unit. Curr. Opin. Crit. Care. 2017. Vol. 23, No. 2. Р. 167–174.Han S., Shannahan S., Pellish R. Fecal microbiota transplant: treatment options for Clostridium difficile infection in the intensive care unit. J. Intensive Care Med. 2015. Vol. 31, No. 9. Р. 577–586.Han S., Shannahan S., Pellish R. Fecal microbiota transplant: treatment options for Clostridium difficile infection in the intensive care unit. J. Intensive Care Med. 2015. Vol. 31, No. 9. Р. 577–586.Jacobs M. C., Haak B. W., Hugenholtz F., Wiersinga W. J. Gut microbiota and host defense in critical illness. Curr. Opin. Crit. Care. 2017. Vol. 23, No. 4. Р. 257–263.Jacobs M. C., Haak B. W., Hugenholtz F., Wiersinga W. J. Gut microbiota and host defense in critical illness. Curr. Opin. Crit. Care. 2017. Vol. 23, No. 4. Р. 257–263.Kau A. L., Ahern P. P., Griffin N. W., Goodman A. L., Gordon J. I. Human nutrition, the gut microbiome and the immune system. Nature. 2011. Vol. 474. P. 327–336.Kau A. L., Ahern P. P., Griffin N. W., Goodman A. L., Gordon J. I. Human nutrition, the gut microbiome and the immune system. Nature. 2011. Vol. 474. P. 327–336.Klingensmith N. J., Coopersmith C. M. The gut as the motor of multiple organ dysfunction in critical illness. Crit. Care Clin. 2016. Vol. 32, No. 2. Р. 203–212.Klingensmith N. J., Coopersmith C. M. The gut as the motor of multiple organ dysfunction in critical illness. Crit. Care Clin. 2016. Vol. 32, No. 2. Р. 203–212.Kelly D., Mulder I. E. Microbiome and immunological interactions. Nutr. Rev. 2012. Vol. 70, Suppl 1. P. S 18–S 30.Kelly D., Mulder I. E. Microbiome and immunological interactions. Nutr. Rev. 2012. Vol. 70, Suppl 1. P. S 18–S 30.Lankelma J. M., Cranendonk D. R., Belzer C., de Vos A. F., de Vos W. M., van der Poll T. et al. Antibiotic-induced gut microbiota disruption during human endotoxemia: a randomised controlled study. Gut. 2017. Vol. 66, No. 9. P. 1623–1630.Lankelma J. M., Cranendonk D. R., Belzer C., de Vos A. F., de Vos W. M., van der Poll T. et al. Antibiotic-induced gut microbiota disruption during human endotoxemia: a randomised controlled study. Gut. 2017. Vol. 66, No. 9. P. 1623–1630.Manzanares W., Langlois P. L., Wischmeyer P. E. Restoring the microbiome in critically ill patients: are probiotics our true friends when we are seriously ill? J. Parenter. Enteral Nutr. 2017. Vol. 41, No. 4. P. 530–533.Manzanares W., Langlois P. L., Wischmeyer P. E. Restoring the microbiome in critically ill patients: are probiotics our true friends when we are seriously ill? J. Parenter. Enteral Nutr. 2017. Vol. 41, No. 4. P. 530–533.McDonald D., Ackermann G., Khailova L., Baird C., Heyland D., Kozar R. et al. Extreme dysbiosis of the microbiome in critical illness. mSphere. 2016. Vol. 1, No. 4. e00199–16.McDonald D., Ackermann G., Khailova L., Baird C., Heyland D., Kozar R. et al. Extreme dysbiosis of the microbiome in critical illness. mSphere. 2016. Vol. 1, No. 4. e00199–16.Schuijt T. J., Lankelma J. M., Scicluna B. P., de Sousa e Melo F., Roelofs J. J., de Boer J. D. et al. The gut microbiota plays a protective role in the host defense against pneumococcal pneumonia. Gut. 2016.Vol. 65, No. 4. Р. 575–583.Schuijt T. J., Lankelma J. M., Scicluna B. P., de Sousa e Melo F., Roelofs J. J., de Boer J. D. et al. The gut microbiota plays a protective role in the host defense against pneumococcal pneumonia. Gut. 2016.Vol. 65, No. 4. Р. 575–583.Белобородова Н. В. Интеграция метаболизма человека и его микробиома при критических состояниях. Общая реаниматология. 2012. Т. 8, No. 4. С. 42–54.Белобородова Н. В. Интеграция метаболизма человека и его микробиома при критических состояниях. Общая реаниматология. 2012. Т. 8, No. 4. С. 42–54.

The authors declare that there are no conflicts of interest present.