La terapia batterica orale nell’ infezione da SARS-CoV2: nuove sfide in corso di pandemia

SARS-CoV-2 may impact on host microbiota and gut inflammation, infecting intestinal epithelial cells. Furthermore, some patients after the resolution of the disease, experience symptoms associated with a syndrome known as Long-Covid characterized by symptoms such as fatigue, "brain fog", similar diffuse pains. The aim of this study was to compare the rate of mortality, the need of ICU hospitalization and the length of hospitalization in patients with severe COVID-19 pneumonia who received the best available therapy (BAT) vs. patients treated with BAT and supplemented with oral bacteriotherapy. We also analyzed the effect of probiotic supplementation in preventing chronic fatigue. Methods: We performed an observational cohort study included 200 adults with COVID-19 pneumonia. All patients received therapeutic regimens including low molecular weight heparin plus one or more between hydroxychloroquine, azithromycin, antivirals, and Tocilizumab. Oral bacteriotherapy (OB) was used as complementary treatment. Subsequently, to evaluate the effect on chronic fatigue, a subgroup of 58 patients hospitalized for COVID-19 was analyzed. 24 (41.4%) received OB during hospitalization (OB+) while 34 (58.6%) taken only the standard treatment (OB–). Serum metabolomic profiling of patients has been performed at both hospital acceptance (T0) and discharge (T1). Six months after discharge, fatigue perceived by participants was assessed by administrating the Fatigue Assessment Scale. Results: Out of the 200 patients, 112 received BAT without oral bacteriotherapy, and 88 BAT with oral bacteriotherapy. Crude mortality was 22%. In the group of patients treated with BAT plus oral bacteriotherapy 11% died as compared to 30% in the group of patients treated with BAT (p < 0.001). By multivariate analysis, age >65 years, C-Reactive Protein >41.8 mg/L, Platelets <150.000 mmc, and cardiovascular events were associated with the increased risk of mortality. Oral bacteriotherapy was associated with a reduced risk for death. From the group of 58 patients investigated for chronic fatigue, 70.7% reported fatigue while 29.3% were negative for such condition. The OB+ group showed a lower proportion of subjects reporting fatigue than the OB– one (p < 0.01). Furthermore, OB+ subjects were characterized by significantly increased concentrations of serum Arginine, Asparagine, Lactate opposite to lower levels of 3-Hydroxyisobutirate. Discussion: this study suggests a possible role for oral bacteriotherapy in the management of patients hospitalized for COVID-19 pneumonia and point out how the administration of probiotics may prevent the development of chronic fatigue by impacting key metabolites involved in the utilization energy pathways.