Challenges in the Management of SARS-CoV2 Infection: The Role of Oral Bacteriotherapy as Complementary Therapeutic Strategy to Avoid the Progression of COVID-19

Gabriella d'Ettorre, Giancarlo Ceccarelli, Massimiliano Marazzato, Giuseppe Campagna, Claudia Pinacchio, Francesco Alessandri, Franco Ruberto, Giacomo Rossi, Luigi Celani, Carolina Scagnolari, Cristina Mastropietro, Vito Trinchieri, Gregorio Egidio Recchia, Vera Mauro, Guido Antonelli, Francesco Pugliese, Claudio Maria Mastroianni, Gabriella d'Ettorre, Giancarlo Ceccarelli, Massimiliano Marazzato, Giuseppe Campagna, Claudia Pinacchio, Francesco Alessandri, Franco Ruberto, Giacomo Rossi, Luigi Celani, Carolina Scagnolari, Cristina Mastropietro, Vito Trinchieri, Gregorio Egidio Recchia, Vera Mauro, Guido Antonelli, Francesco Pugliese, Claudio Maria Mastroianni

Abstract

Background: Gastrointestinal disorders are frequent in COVID-19 and SARS-CoV-2 has been hypothesized to impact on host microbial flora and gut inflammation, infecting intestinal epithelial cells. Since there are currently no coded therapies or guidelines for treatment of COVID-19, this study aimed to evaluate the possible role of a specific oral bacteriotherapy as complementary therapeutic strategy to avoid the progression of COVID-19. Methods: We provide a report of 70 patients positive for COVID-19, hospitalized between March 9th and April 4th, 2020. All the patients had fever, required non-invasive oxygen therapy and presented a CT lung involvement on imaging more than 50%. Forty-two patients received hydroxychloroquine, antibiotics, and tocilizumab, alone or in combination. A second group of 28 subjects received the same therapy added with oral bacteriotherapy, using a multistrain formulation. Results: The two cohorts of patients were comparable for age, sex, laboratory values, concomitant pathologies, and the modality of oxygen support. Within 72 h, nearly all patients treated with bacteriotherapy showed remission of diarrhea and other symptoms as compared to less than half of the not supplemented group. The estimated risk of developing respiratory failure was eight-fold lower in patients receiving oral bacteriotherapy. Both the prevalence of patients transferred to ICU and mortality were higher among the patients not treated with oral bacteriotherapy. Conclusions: A specific bacterial formulation showed a significant ameliorating impact on the clinical conditions of patients positive for SARS-CoV-2 infection. These results also stress the importance of the gut-lung axis in controlling the COVID-19 disease.

Keywords: COVID-19; SARS-CoV-2; bacteriotherapy; gut; gut-lung axis; lactobacillus; probiotic.

Copyright © 2020 d'Ettorre, Ceccarelli, Marazzato, Campagna, Pinacchio, Alessandri, Ruberto, Rossi, Celani, Scagnolari, Mastropietro, Trinchieri, Recchia, Mauro, Antonelli, Pugliese and Mastroianni.

Figures

Figure 1
Figure 1
Color-coded barplots based on probiotic administration showing the disappearance of diarrhea (A) as well as other symptoms (B) at different time points. The Benjamini Hochberg FDR correction was used to account for multiple hypothesis testing. Statistical significance between the group at alpha level 0.05 was also reported.
Figure 2
Figure 2
Analysis of the longitudinal data for the respiration variable in relation to the “OB– vs. OB+” group performed by GLIMMIX. For each time point, the odds ratio, the confidence interval 95% and the statistical significance were reported.

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