medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-13-36-40medsovet-3823Research ArticleКлиническая лекцияClinical lectureВлияние микробиома грудного молока на здоровье матери и новорожденногоEffect of breast milk microbiome on the health of mothers and newbornshttps://orcid.org/0000-0001-6117-7270ПустотинаО. А.PustotinaО. A.

Пустотина Ольга Анатольевна, доктор медицинских наук, профессор кафедры акушерства и гинекологии с курсом репродуктивной медицины, Частное образовательное учреждение дополнительного профессионального образования

191196, Санкт-Петербург, ул. Миллионная, д. 29, литер А

Olga A. Pustotina, Dr. of Sci. (Med.), Professor of Chair for Obstetrics and Gynecology with Reproductive Medicine Module, Private Educational Institution of Additional Professional Education

29A, Millionnaya Street, Saint Petersburg, 191196

Pustotina@gmail.comСеливерстовА. А.SeliverstovA. A.

Селиверстов Александр Анатольевич, кандидат медицинских наук, врач акушер-гинеколог

115407, Москва, ул. Судостроительная, д. 40 

Alexander A. Seliverstov, Cand. of Sci. (Med.), Obstetrics and Gynecology Doctor

40, Sudostroitelnaya Street, Moscow, 115407

aac-06@mail.ruАкадемия медицинского образования им. Ф.И. ИноземцеваРоссияAcademy of Medical Education named after F.I. InozemtsevRussian FederationМногопрофильный медицинский центр «Женское здоровье»;РоссияMultidisciplinary Women’s Health CenterRussian Federation2019091020190133640Copyright © Пустотина О.А., Селиверстов А.А., 20192019Пустотина О.А., Селиверстов А.А.Pustotina О.A., Seliverstov A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/3823

В статье изложены современные данные о микробном составе грудного молока у здоровых женщин и женщин с лактационным маститом. Описаны основные пути формирования микробиома молочных желез и его влияние на здоровье матери и новорожденного. Обоснована целесообразность использования пробиотических средств, созданных на основе выделенных из грудного молока штаммов молочнокислых бактерий, как для лечения лактационного мастита, так и для его профилактики в группах риска.

The article presents updated data on the microbial composition of breast milk in healthy women and women with lactational mastitis. The authors describe the main ways of the formation of mammary gland microbiome and its effect on the maternal and newborn health. The feasibility of using probiotic agents created on the basis of strains of lactic acid bacteria isolated from breast milk is substantiated both for the treatment of lactational mastitis and for its prevention in risk groups.

микробиом грудного молокалактостазмаститLactobacillus fermentumbreast milk microbiomelactostasismastitisLactobacillus fermentumReferencesChantry C.J., Eglash A., Labbok M. ABM Position on Breastfeeding-Revised 2015. Breastfeed Med. 2015;10(9):407-411. doi: 10.1089/bfm.2015.29012.cha.Chantry C.J., Eglash A., Labbok M. ABM Position on Breastfeeding-Revised 2015. Breastfeed Med. 2015;10(9):407-411. doi: 10.1089/bfm.2015.29012.cha.Hauk L. AAFP Releases Position Paper on Breastfeeding. Am Fam Physician. 2015;91(1):56-57. Available at: https://www.researchgate.net/publication/270963869_AAFP_Releases_Position_Paper_on_Breastfeeding/citation/download.Hauk L. AAFP Releases Position Paper on Breastfeeding. Am Fam Physician. 2015;91(1):56-57. Available at: https://www.researchgate.net/publication/270963869_AAFP_Releases_Position_Paper_on_Breastfeeding/citation/download.Jeurink P.V., Rijnierse A., Martín R., Garssen J., Knippels L.M. Difficulties in describing allergic disease modulation by pre-, proand synbiotics. Curr Pharm Des. 2012;18(16):2369-2374. doi: 10.2174/138161212800166031.Jeurink P.V., Rijnierse A., Martín R., Garssen J., Knippels L.M. Difficulties in describing allergic disease modulation by pre-, proand synbiotics. Curr Pharm Des. 2012;18(16):2369-2374. doi: 10.2174/138161212800166031.Penttila I.A. Milk-derived transforming growth factor-β and the infant immune response. J Pediatr. 2010;156(2 Suppl):21-25. doi: 10.1016/j.jpeds.2009.11.016.Penttila I.A. Milk-derived transforming growth factor-β and the infant immune response. J Pediatr. 2010;156(2 Suppl):21-25. doi: 10.1016/j.jpeds.2009.11.016.Aakko J., Kumar H., Rautava S., Wise A., Autran C., Bode L., Isolauri E., Salminen S. Human milk oligosaccharide categories define the microbiota composition in human colostrum. Benef Microbes. 2017;8(4):563-567. doi: 10.3920/BM2016.0185.Aakko J., Kumar H., Rautava S., Wise A., Autran C., Bode L., Isolauri E., Salminen S. Human milk oligosaccharide categories define the microbiota composition in human colostrum. Benef Microbes. 2017;8(4):563-567. doi: 10.3920/BM2016.0185.Victora C.G., Bahl R., Barros A.J., Franca G.V., Horton S., Krasevec J., Murch S., Sankar M.J., Walker N., Rollins N.C. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475490. doi: 10.1016/S0140-6736(15)01024-7.Victora C.G., Bahl R., Barros A.J., Franca G.V., Horton S., Krasevec J., Murch S., Sankar M.J., Walker N., Rollins N.C. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475490. doi: 10.1016/S0140-6736(15)01024-7.Ip S., Chung M., Raman G., Chew P., Magula N., DeVine D., Trikalinos T., Lau J. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007;(153):1-186. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17764214.Ip S., Chung M., Raman G., Chew P., Magula N., DeVine D., Trikalinos T., Lau J. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007;(153):1-186. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17764214.Всемирная организация здравоохранения. Здоровье матерей, новорожденных, детей и подростков. Режим доступа: https://www.who.int/maternal_child_adolescent/topics/child/nutrition/breastfeeding/ru/World HealthOrganization. Maternal, newborn,child andadolescent health. (In Russ.) Available at: https://www.who.int/maternal_child_adolescent/topics/child/nutrition/breastfeeding/ru/Hunt K.M., Foster J.A., Forney L.J., Schutte U.M., Beck D.L., Abdo Z., Fox L.K., Williams J.E., McGuire M.K., McGuire M.A. Characterization of the diversity and temporal stability of bacterial communities in human milk. PLoS One. 2011;6(6):e21313. doi: 10.1371/journal.pone.0021313.Hunt K.M., Foster J.A., Forney L.J., Schutte U.M., Beck D.L., Abdo Z., Fox L.K., Williams J.E., McGuire M.K., McGuire M.A. Characterization of the diversity and temporal stability of bacterial communities in human milk. PLoS One. 2011;6(6):e21313. doi: 10.1371/journal.pone.0021313.Jimenez E., de Andres J., Manrique M., Pareja-Tobes P., Tobes R., Martinez-Blanch J.F., Codoner F.M., Ramon D., Fernandez L., Rodriguez J.M. Metagenomic analysis of milk of healthy and mastitissuffering women. J Hum Lact. 2015;31(3):406415. doi: 10.1177/0890334415585078.Jimenez E., de Andres J., Manrique M., Pareja-Tobes P., Tobes R., Martinez-Blanch J.F., Codoner F.M., Ramon D., Fernandez L., Rodriguez J.M. Metagenomic analysis of milk of healthy and mastitissuffering women. J Hum Lact. 2015;31(3):406415. doi: 10.1177/0890334415585078.Urbaniak C., Angelini M., Gloor G.B., Reid G. Human milk microbiota profiles in relation to birthing method, gestation and infant gender. Microbiome. 2016;4:1. doi: 10.1186/s40168-015-0145-y.Urbaniak C., Angelini M., Gloor G.B., Reid G. Human milk microbiota profiles in relation to birthing method, gestation and infant gender. Microbiome. 2016;4:1. doi: 10.1186/s40168-015-0145-y.Murphy K., Curley D., O’Callaghan T.F., O’Shea C.A., Dempsey E.M., O’Toole P.W., Ross R.P., Ryan C.A., Stanton C. The Composition of Human Milk and Infant Faecal Microbiota Over the First Three Months of Life: A Pilot Study. Sci Rep. 2017;7:40597. doi: 10.1038/srep40597.Murphy K., Curley D., O’Callaghan T.F., O’Shea C.A., Dempsey E.M., O’Toole P.W., Ross R.P., Ryan C.A., Stanton C. The Composition of Human Milk and Infant Faecal Microbiota Over the First Three Months of Life: A Pilot Study. Sci Rep. 2017;7:40597. doi: 10.1038/srep40597.Boix-Amoros A., Martinez-Costa C., Querol A., Collado M.C., Mira A. Multiple approaches detect the presence of fungi in human breastmilk samples from healthy mothers. Sci Rep. 2017;7(1):13016. doi: 10.1038/s41598-01713270-x.Boix-Amoros A., Martinez-Costa C., Querol A., Collado M.C., Mira A. Multiple approaches detect the presence of fungi in human breastmilk samples from healthy mothers. Sci Rep. 2017;7(1):13016. doi: 10.1038/s41598-01713270-x.Ojo-Okunola A., Nicol M., du Toit E. Human breast milk bacteriome in health and disease. Nutrients. 2018;10(11):pii: E1643. doi: 10.3390/nu10111643.Ojo-Okunola A., Nicol M., du Toit E. Human breast milk bacteriome in health and disease. Nutrients. 2018;10(11):pii: E1643. doi: 10.3390/nu10111643.Pannaraj P.S., Li F., Cerini C., Bender J.M., Yang S., Rollie A., Adisetiyo H., Zabih S., Lincez P.J., Bittinger K., Bailey A., Bushman F.D., Sleasman J.W., Aldrovandi G.M. Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome. JAMA Pediatr. 2017;171(7):647654. doi: 10.1001/jamapediatrics.2017.0378.Pannaraj P.S., Li F., Cerini C., Bender J.M., Yang S., Rollie A., Adisetiyo H., Zabih S., Lincez P.J., Bittinger K., Bailey A., Bushman F.D., Sleasman J.W., Aldrovandi G.M. Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome. JAMA Pediatr. 2017;171(7):647654. doi: 10.1001/jamapediatrics.2017.0378.Hunt K.M., Foster J.A., Forney L.J., Schutte U.M., Beck D.L., Abdo Z., Fox L.K., Williams J.E., McGuire M.K., McGuire M.A. Characterization of the diversity and temporal stability of bacterial communities in human milk. PLoS One. 2011;6(6):e21313. doi: 10.1371/journal.pone.0021313.Hunt K.M., Foster J.A., Forney L.J., Schutte U.M., Beck D.L., Abdo Z., Fox L.K., Williams J.E., McGuire M.K., McGuire M.A. Characterization of the diversity and temporal stability of bacterial communities in human milk. PLoS One. 2011;6(6):e21313. doi: 10.1371/journal.pone.0021313.Rodriguez J.M. The origin of human milk bacteria: Is there a bacterial entero-mammary pathway during late pregnancy and lactation? Adv Nutr. 2014;5(6):779-784. doi: 10.3945/an.114.007229.Rodriguez J.M. The origin of human milk bacteria: Is there a bacterial entero-mammary pathway during late pregnancy and lactation? Adv Nutr. 2014;5(6):779-784. doi: 10.3945/an.114.007229.Zhou X., Voigt A., Paveglio S., Weinstock G., Matson A., Davidovics Z. Similar bacterial signatures in intestinal tissues, milk, and dendritic cells of lactating mice suggest a possible entero-mammary pathway. Gastroenterology. 2017;152(5):172. doi: 10.1016/S0016-5085(17)30893-4.Zhou X., Voigt A., Paveglio S., Weinstock G., Matson A., Davidovics Z. Similar bacterial signatures in intestinal tissues, milk, and dendritic cells of lactating mice suggest a possible entero-mammary pathway. Gastroenterology. 2017;152(5):172. doi: 10.1016/S0016-5085(17)30893-4.Charoenphandhu N., Nakkrasae L.I., Kraidith K., Teerapornpuntakit J., Thongchote K., Thongon N., Krishnamra N. Twostep stimulation of intestinal Ca(2+) absorption during lactation by long-term prolactin exposure and sucklinginduced prolactin surge. Am J Physiol Endocrinol Metab. 2009;297(3):609-619. doi: 10.1152/ajpendo.00347.2009.Charoenphandhu N., Nakkrasae L.I., Kraidith K., Teerapornpuntakit J., Thongchote K., Thongon N., Krishnamra N. Twostep stimulation of intestinal Ca(2+) absorption during lactation by long-term prolactin exposure and sucklinginduced prolactin surge. Am J Physiol Endocrinol Metab. 2009;297(3):609-619. doi: 10.1152/ajpendo.00347.2009.Asnicar F., Manara S., Zolfo M., Truong D.T., Scholz M., Armanini F., Ferretti P., Gorfer V., Pedrotti A., Tett A., Segata N. Studying vertical microbiome transmission from mothers to infants by strain-level metagenomic profiling. mSystems. 2017;2(1):e00164-16:pii: e00164-16. doi: 10.1128/mSystems.00164-16.Asnicar F., Manara S., Zolfo M., Truong D.T., Scholz M., Armanini F., Ferretti P., Gorfer V., Pedrotti A., Tett A., Segata N. Studying vertical microbiome transmission from mothers to infants by strain-level metagenomic profiling. mSystems. 2017;2(1):e00164-16:pii: e00164-16. doi: 10.1128/mSystems.00164-16.Murphy K., Curley D., O’Callaghan T.F., O’Shea C.A., Dempsey E.M., O’Toole P.W., Ross R.P., Ryan C.A., Stanton C. The composition of human milk and infant faecal microbiota over the first three months of life: A pilot study. Sci Rep. 2017;7:40597. doi: 10.1038/srep40597.Murphy K., Curley D., O’Callaghan T.F., O’Shea C.A., Dempsey E.M., O’Toole P.W., Ross R.P., Ryan C.A., Stanton C. The composition of human milk and infant faecal microbiota over the first three months of life: A pilot study. Sci Rep. 2017;7:40597. doi: 10.1038/srep40597.Walker W.A., Iyengar, R.S. Breast milk, microbiota, and intestinal immune homeostasis. Pediatr Res. 2015;77(1-2):220-228. doi: 10.1038/pr.2014.160.Walker W.A., Iyengar, R.S. Breast milk, microbiota, and intestinal immune homeostasis. Pediatr Res. 2015;77(1-2):220-228. doi: 10.1038/pr.2014.160.Donnet-Hughes A., Perez P.F., Dore J., Leclerc M., Levenez F., Benyacoub J., Serrant P., SeguraRoggero I., Schiffrin E.J. Potential role of the intestinal microbiota of the mother in neonatal immune education. Proc Nutr Soc. 2010;69(3):407415. doi: 10.1017/S0029665110001898.Donnet-Hughes A., Perez P.F., Dore J., Leclerc M., Levenez F., Benyacoub J., Serrant P., SeguraRoggero I., Schiffrin E.J. Potential role of the intestinal microbiota of the mother in neonatal immune education. Proc Nutr Soc. 2010;69(3):407415. doi: 10.1017/S0029665110001898.Kim J.Y., Woo H.J., Kim Y.S., Kim K.H., Lee H.J. Cell cycle dysregulation induced by cytoplasm of Lactococcus lactis ssp lactis in SNUC2A, a colon cancer cell line. Nutr Cancer. 2003;46(2):197-201. doi: 10.1207/S15327914NC4602_13.Kim J.Y., Woo H.J., Kim Y.S., Kim K.H., Lee H.J. Cell cycle dysregulation induced by cytoplasm of Lactococcus lactis ssp lactis in SNUC2A, a colon cancer cell line. Nutr Cancer. 2003;46(2):197-201. doi: 10.1207/S15327914NC4602_13.Olivares M., Diaz-Ropero M.P., Martin R., Rodriguez J.M., Xaus J. Antimicrobial potential of four lactobacillus strains isolated from breast milk. J Appl Microbiol. 2006 Jul;101(1):7279. doi: 10.1111/j.1365-2672.2006.02981.x.Olivares M., Diaz-Ropero M.P., Martin R., Rodriguez J.M., Xaus J. Antimicrobial potential of four lactobacillus strains isolated from breast milk. J Appl Microbiol. 2006 Jul;101(1):7279. doi: 10.1111/j.1365-2672.2006.02981.x.Ajetunmobi O.M., Whyte B., Chalmers J., Tappin D.M., Wolfson L., Fleming M., MacDonald A., Wood R., Stockton D.L.; Glasgow Centre for Population Health Breastfeeding Project Steering Group. Breastfeeding is associated with reduced childhood hospitalization: evidence from a Scottish Birth Cohort (19972009). J Pediatr. 2015;166(3):620-625.e4. doi: 10.1016/j.jpeds.2014.11.013.Ajetunmobi O.M., Whyte B., Chalmers J., Tappin D.M., Wolfson L., Fleming M., MacDonald A., Wood R., Stockton D.L.; Glasgow Centre for Population Health Breastfeeding Project Steering Group. Breastfeeding is associated with reduced childhood hospitalization: evidence from a Scottish Birth Cohort (19972009). J Pediatr. 2015;166(3):620-625.e4. doi: 10.1016/j.jpeds.2014.11.013.Gil-Campos M., Lopez M.A., Rodriguez-Benitez M.V., Romero J., Roncero I., Linares M.D., Maldonado J., Lopez-Huertas E., Berwind R., Ritzenthaler K.L., Navas V., Sierra C., Sempere L., Geerlings A., Maldonado-Lobon J.A., Valero A.D., Lara-Villoslada F., Olivares M. Lactobacillus fermentum CECT 5716 is safe and well tolerated in infants of 1–6 months of age: A Randomized Controlled Trial. Pharmacol Res. 2012 Feb;65(2):231-238. doi: 10.1016/j.phrs.2011.11.016.Gil-Campos M., Lopez M.A., Rodriguez-Benitez M.V., Romero J., Roncero I., Linares M.D., Maldonado J., Lopez-Huertas E., Berwind R., Ritzenthaler K.L., Navas V., Sierra C., Sempere L., Geerlings A., Maldonado-Lobon J.A., Valero A.D., Lara-Villoslada F., Olivares M. Lactobacillus fermentum CECT 5716 is safe and well tolerated in infants of 1–6 months of age: A Randomized Controlled Trial. Pharmacol Res. 2012 Feb;65(2):231-238. doi: 10.1016/j.phrs.2011.11.016.Maldonado J., Canabate F., Sempere L., Vela F., Sanchez A.R., Narbona E., Lopez-Huertas E., Geerlings A., Valero A.D., Olivares M., LaraVilloslada F. The Human milk probiotic Lactobacillus fermentum CECT5716 reduces the incidence of gastrointestinal and upper respiratory tract infections in infants. J Pediatr Gastroenterol Nutr. 2012;54(1):55-61. doi: 10.1097/MPG.0b013e3182333f18.Maldonado J., Canabate F., Sempere L., Vela F., Sanchez A.R., Narbona E., Lopez-Huertas E., Geerlings A., Valero A.D., Olivares M., LaraVilloslada F. The Human milk probiotic Lactobacillus fermentum CECT5716 reduces the incidence of gastrointestinal and upper respiratory tract infections in infants. J Pediatr Gastroenterol Nutr. 2012;54(1):55-61. doi: 10.1097/MPG.0b013e3182333f18.Lara-Villoslada F., Olivares M., Sierra S., Rodriguez J.M., Boza J., Xaus J. Beneficial effects of probiotic bacteria isolated from breast milk. Br J Nutr. 2007;98(Suppl 1):96-100. doi: 10.1017/S0007114507832910.Lara-Villoslada F., Olivares M., Sierra S., Rodriguez J.M., Boza J., Xaus J. Beneficial effects of probiotic bacteria isolated from breast milk. Br J Nutr. 2007;98(Suppl 1):96-100. doi: 10.1017/S0007114507832910.Kim J.Y., Kwon J.H., Ahn S.H., Lee S.I., Han Y.S., Choi Y.O., Lee S.Y., Ahn K.M., Ji G.E. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: A doubleblind, randomized, placebo-controlled trial. Pediatr Allergy Immunol. 2010;21(2 Pt 2):e386393. doi: 10.1111/j.1399-3038.2009.00958.x.Kim J.Y., Kwon J.H., Ahn S.H., Lee S.I., Han Y.S., Choi Y.O., Lee S.Y., Ahn K.M., Ji G.E. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: A doubleblind, randomized, placebo-controlled trial. Pediatr Allergy Immunol. 2010;21(2 Pt 2):e386393. doi: 10.1111/j.1399-3038.2009.00958.x.Hassan Z., Mustafa S., Rahim R.A., Isa N.M. Antibreast cancer effects of live, heat-killed and cytoplasmic fractions of enterococcus faecalis and staphylococcus hominis isolated from human breast milk. In Vitro Cell Dev Biol Anim. 2016 Mar;52(3):337348. doi: 10.1007/s11626-015-9978-8.Hassan Z., Mustafa S., Rahim R.A., Isa N.M. Antibreast cancer effects of live, heat-killed and cytoplasmic fractions of enterococcus faecalis and staphylococcus hominis isolated from human breast milk. In Vitro Cell Dev Biol Anim. 2016 Mar;52(3):337348. doi: 10.1007/s11626-015-9978-8.Patel S.H., Vaidya Y.H., Patel R.J., Pandit R.J., Joshi C.G., Kunjadiya A.P. Culture independent assessment of human milk microbial community in lactational mastitis. Sci Rep. 2017;7(1):7804. doi: 10.1038/s41598-017-08451-7.Patel S.H., Vaidya Y.H., Patel R.J., Pandit R.J., Joshi C.G., Kunjadiya A.P. Culture independent assessment of human milk microbial community in lactational mastitis. Sci Rep. 2017;7(1):7804. doi: 10.1038/s41598-017-08451-7.Amir L.H. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeed Med. 2014; 9(5): 239–243. doi: 10.1089/bfm.2014.9984.Amir L.H. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeed Med. 2014; 9(5): 239–243. doi: 10.1089/bfm.2014.9984.Delgado S., Arroyo R., Jimenez E., Marin M.L., del Campo R., Fernandez L., Rodriguez J.M. Staphylococcus epidermidis strains isolated from breast milk of women suffering infectious mastitis: Potential virulence traits and resistance to antibiotics. BMC Microbiol. 2009;9:82. doi: 10.1186/1471-2180-9-82.Delgado S., Arroyo R., Jimenez E., Marin M.L., del Campo R., Fernandez L., Rodriguez J.M. Staphylococcus epidermidis strains isolated from breast milk of women suffering infectious mastitis: Potential virulence traits and resistance to antibiotics. BMC Microbiol. 2009;9:82. doi: 10.1186/1471-2180-9-82.Fernández L., Langa S., Martin V., Maldonado A., Jimenez E., Martin R., Rodriguez J.M. The human milk microbiota: origin and potential roles in health and disease. Pharmacol Res. 2013;69(1):110. doi: 10.1016/j.phrs.2012.09.001.Fernández L., Langa S., Martin V., Maldonado A., Jimenez E., Martin R., Rodriguez J.M. The human milk microbiota: origin and potential roles in health and disease. Pharmacol Res. 2013;69(1):110. doi: 10.1016/j.phrs.2012.09.001.Davies D. Understanding biofilm resistance to antibacterial agents. Nat Rev Drug Discov. 2003;2(2):114–122. doi: 10.1038/nrd1008.Davies D. Understanding biofilm resistance to antibacterial agents. Nat Rev Drug Discov. 2003;2(2):114–122. doi: 10.1038/nrd1008.Donlan R.M., Costerton J.W. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002;15(2):167-193. doi: 10.1128/cmr.15.2.167-193.2002.Donlan R.M., Costerton J.W. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002;15(2):167-193. doi: 10.1128/cmr.15.2.167-193.2002.Arroyo R., Martin V., Maldonado A., Jimenez E., Fernandez L., Rodriguez J.M. Treatment of infectious mastitis during lactation: antibiotics versus oral administration of Lactobacilli isolated from breast milk. Clin Infect Dis. 2010;50(12):1551-1558. doi: 10.1086/652763.Arroyo R., Martin V., Maldonado A., Jimenez E., Fernandez L., Rodriguez J.M. Treatment of infectious mastitis during lactation: antibiotics versus oral administration of Lactobacilli isolated from breast milk. Clin Infect Dis. 2010;50(12):1551-1558. doi: 10.1086/652763.Hurtado J.A., Maldonado-Lobon J.A., Diaz-Ropero M.P., Flores-Rojas K., Uberos J., Leante J.L., Affumicato L., Couce M.L., Garrido J.M., Olivares M., Fonolla J. Oral Administration to Nursing Women of Lactobacillus fermentum CECT5716 Prevents Lactational Mastitis Development: A Randomized Controlled Trial. Breastfeed Med. 2017;12(4):202–209. doi: 10.1089/bfm.2016.0173.Hurtado J.A., Maldonado-Lobon J.A., Diaz-Ropero M.P., Flores-Rojas K., Uberos J., Leante J.L., Affumicato L., Couce M.L., Garrido J.M., Olivares M., Fonolla J. Oral Administration to Nursing Women of Lactobacillus fermentum CECT5716 Prevents Lactational Mastitis Development: A Randomized Controlled Trial. Breastfeed Med. 2017;12(4):202–209. doi: 10.1089/bfm.2016.0173.Rybalchenko O.V., Bondarenko V.M., Orlova O.G., Markov A.G., Amasheh S. Inhibitory effects of Lactobacillus fermentum on microbial growth and biofilm formation. Arch Microbiol. 2015;197(8):10271032. doi: 10.1007/s00203-015-1140-1.Rybalchenko O.V., Bondarenko V.M., Orlova O.G., Markov A.G., Amasheh S. Inhibitory effects of Lactobacillus fermentum on microbial growth and biofilm formation. Arch Microbiol. 2015;197(8):10271032. doi: 10.1007/s00203-015-1140-1.Cardenas N., Laino J.E., Delgado S., Jimenez E., Juarez del Valle M., Savoy de Giori G., Sesma F., Mayo B., Fernandez L., LeBlanc J.G., Rodriguez J.M. Relationships between the genome and some phenotypical properties of Lactobacillus fermentum CECT 5716, a probiotic strain isolated from human milk. Appl Microbiol Biotechnol. 2015;99(10):43434353. doi: 10.1007/s00253-015-6429-0.Cardenas N., Laino J.E., Delgado S., Jimenez E., Juarez del Valle M., Savoy de Giori G., Sesma F., Mayo B., Fernandez L., LeBlanc J.G., Rodriguez J.M. Relationships between the genome and some phenotypical properties of Lactobacillus fermentum CECT 5716, a probiotic strain isolated from human milk. Appl Microbiol Biotechnol. 2015;99(10):43434353. doi: 10.1007/s00253-015-6429-0.Kang M.S., Lim H.S., Oh J.S., Lim Y.J., WuertzKozak K., Harro J.M., Shirtliff M.E., Achermann Y. Antimicrobial activity of Lactobacillus salivarius and Lactobacillus fermentum against Staphylococcus aureus. Pathog Dis. 2017;75(2). doi: 10.1093/femspd/ftx009.Kang M.S., Lim H.S., Oh J.S., Lim Y.J., WuertzKozak K., Harro J.M., Shirtliff M.E., Achermann Y. Antimicrobial activity of Lactobacillus salivarius and Lactobacillus fermentum against Staphylococcus aureus. Pathog Dis. 2017;75(2). doi: 10.1093/femspd/ftx009.Diaz-Ropero M.P., Martin R., Sierra S., LaraVilloslada F., Rodriguez J.M., Xaus J., Olivares M. Two Lactobacillus strains, isolated from breast milk, differently modulate the immune response. J Appl Microbiol. 2007;102(2):337-343. doi: 10.1111/j.1365-2672.2006.03102.x.Diaz-Ropero M.P., Martin R., Sierra S., LaraVilloslada F., Rodriguez J.M., Xaus J., Olivares M. Two Lactobacillus strains, isolated from breast milk, differently modulate the immune response. J Appl Microbiol. 2007;102(2):337-343. doi: 10.1111/j.1365-2672.2006.03102.x.Perez-Cano F.J., Dong H., Yaqoob P. In vitro immunomodulatory activity of lactobacillus fermentum cect5716 and lactobacillus salivarius cect5713: Two probiotic strains isolated from human breast milk. Immunobiology. 2010;215(12):996-1004. doi: 10.1016/j.imbio.2010.01.004.Perez-Cano F.J., Dong H., Yaqoob P. In vitro immunomodulatory activity of lactobacillus fermentum cect5716 and lactobacillus salivarius cect5713: Two probiotic strains isolated from human breast milk. Immunobiology. 2010;215(12):996-1004. doi: 10.1016/j.imbio.2010.01.004.Maldonado-Lobo.n J.A., Diaz-Lopez M.A., Carputo R., Duarte P., Diaz-Ropero M.P., Valero A.D., Sanudo A., Sempere L., Ruiz-Lopez M.D., Banuelos O., Fonolla J., Olivares Martin M. Lactobacillus fermentum CECT 5716 Reduces Staphylococcus Load in the Breastmilk of Lactating Mothers Suffering Breast Pain: A Randomized Controlled Trial. Breastfeed Med. 2015;10(9):425-432. doi: 10.1089/bfm.2015.0070.Maldonado-Lobo.n J.A., Diaz-Lopez M.A., Carputo R., Duarte P., Diaz-Ropero M.P., Valero A.D., Sanudo A., Sempere L., Ruiz-Lopez M.D., Banuelos O., Fonolla J., Olivares Martin M. Lactobacillus fermentum CECT 5716 Reduces Staphylococcus Load in the Breastmilk of Lactating Mothers Suffering Breast Pain: A Randomized Controlled Trial. Breastfeed Med. 2015;10(9):425-432. doi: 10.1089/bfm.2015.0070.Пустотина О.А., Павлютенкова Ю.Аю Лактационный мастит и лактостаз. Российский вестник акушера-гинеколога. 2007;(2):55-57. Режим доступа: https://medznate.ru/docs/index-41000.html.Pustotina O.A., Pavlyutenkova Yu.A. Puerperal mastitis and lactostasis. Rossiyskiy vestnik akusheraginekologa = Russian Bulletin of ObstetricianGynecologist. 2007;(2):55-57. (In Russ.) Available at: https://medznate.ru/docs/index-41000.html.Ojo-Okunola A., Nicol M., du Toit E. Human breast milk bacteriome in health and disease. Nutrients. 2018;10(1 1). pii: E1643. doi: 10.3390/nu10111643.Ojo-Okunola A., Nicol M., du Toit E. Human breast milk bacteriome in health and disease. Nutrients. 2018;10(1 1). pii: E1643. doi: 10.3390/nu10111643.

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