CHANGES IN THE ENTERAL PATHOBIOME AND FEATURES OF ACUTE INTESTINAL FAILURE IN PATIENTS WITH PERITONITIS DURING THE COVID-19 PANDEMIC
The study of the features of the enteral pathobiome, biochemical, functional, pro-inflammatory and anti-apoptotic markers in diffuse peritonitis was carried out; the features of acute enteral insufficiency in patients with COVID-19 were studied. A retrospective, randomized, cohort, controlled study of 84 patients was conducted, which were divided into two groups. Stratified randomization was used. The species composition and properties of the enteral luminal pathobiome were studied. 699 inoculations were performed, 3024 isolates were obtained. Dynamically studied: enteral morphofunctional coefficient, the level of total alkaline phosphatase, as well as its intestinal isoform. In immunohistochemical studies, the expression of CD-3 and Bcl-2 was studied. In patients with COVID-19, a decrease in the level of saprophytic microflora was noted. Significant growth of Klebsiella spp., Candida, Clostridium spp. and Citrobacter (p≤0.05). The percentage of antibiotic resistance in the comparison group was 8.3%, in the main group - 36.9% (p≤0.05). MRSA pathogens were noted in 86.4% of cases, vancomycin-resistant strains of Staphylococcus aureus were found in 20.6% of cases. In patients with COVID-19, intestinal alkaline phosphatase deficiency was noted, which persisted on the 5th day of treatment. Macro- and microscopic studies showed pronounced inflammatory and apoptotic changes in the intestinal wall of patients in the main group. A specific enteral pathobiome that is multiresistant to antibiotics, pronounced inflammatory and apoptotic changes in the intestinal wall, and a predisposition to perforation of the small intestine are features of enteral insufficiency in diffuse peritonitis in patients with a new coronavirus infection.