The human gut microbiota is a complex, dynamic system consisting of many groups of microorganisms that interact with each other and with the human body. The most correct way to assess the gut microbiota is to consider all groups of microorganisms as components of one whole. The ENTEROFLOR Kiddy assay includes 43 markers that covers at least 99.9% of children's gut microbiota.

The ENTEROFLOR Kiddy test is intended for the diagnostics of gut disbiosis associated with chronic inflammatory processes, long-term indigestion, antibiotics therapy, etc. If causative agents were not detected in patient with symptoms of acute gastroenteritis (vomiting, diarrhea, abdominal pain), the ENTEROFLOR Kiddy test can be prescribed.

The conclusion-forming algorithm is designed for children up to 14 years old. Results for patients older than 14 years old may not be correct.

The microbiological culture and the PCR assay are based on two different technologies, so the results may differ.
50-80% of the gut microorganisms are difficult to cultivate and therefore are not detected by the microbiological method. The results of microbiological culture directly depend on the viability of microorganisms that is influenced by storage and transport conditions.
The ENTEROFLOR Kiddy assay is based on real-time PCR - a direct method of microorganism identification by analyzing DNA fragments, which does not require the preservation of viability.

The ENTEROFLOR Kiddy assay identifies methicillin resistance gene of Staphylococcus spp. - mecA. We recommend to use the BacResista GLA assay to identify a wider range of antibiotic resistance genes by PCR. Also it is possible to combine the ENTEROFLOR Kiddy assay with microbiological culture methods to determine antibiotic sensitivity of the same sample.

The state of normobiosis reflects a dynamic balance between the components of the microbiota (with a predominance of normobiota representatives). Possible deviations from the reference interval for individual representatives of the normobiota can be mutually compensated. This can be explained by functional redundancy of the microbiota: a number of functions can be performed by representatives of different groups of microorganisms. For example, both Bifidobacteria and Bacteroides species can take part in starch utilization.

The results of pathogenicity and resistance markers detection exceeding threshold values should be interpreted taking into account the clinical picture of a particular patient.
In Streptococcus agalactiae the carriage of the srr2 gene is associated the its ability to penetrate human cells and potentially induce encephalitis in newborns.

Staphylococcus spp., including methicillin-resistant (mecA+) strains are normal components of the gut microbiome. Colonization by antibiotic-resistant microorganisms becomes more likely in the gut with dysbiosis. In this case non-selective antibiotic therapy can lead to the emergence of multi-resistant Staphylococcus spp., an increase in its abundance, and a decrease in the barrier function of the gut microbiota that can lead to complications, such as sepsis.
Toxigenic and non-toxigenic strains of C.difficile can be found in children under 2 years old and its carriage is not a threat to the child health presumably due to the absence of toxin receptors in children's enterocytes. As the child's immune system matures, C.difficile is normally displaced from the gut microbiota. In children over 2 years old the toxigenic strains of C.difficile must not be present.

Normally the phylum Firmicutes which includes a huge number of normobiota bacteria, prevails over the phylum Bacteroidetes. However, the Firmicutes/ Bacteroidetes ratio is decreased in inflammatory gut diseases such as ulcerative colitis, Crohn's disease and others.

The determination of gut inflammation markers is not provided by the assay, but a decrease in the Firmicutes/Bacteroidetes ratio indirectly indicates the presence of a chronic inflammatory process in the gut.

Feces or meconium samples may be transported and stored:

• at room temperature (from 18 °C to 25 °C) – no more than 6 hours;
• at temperatures from 2 °C to 8 °C – no more than 3 days.

Storaged as glycerol suspension:

• at -20 °C – within 1 week;
• at -70 °C – for a long time.

The results of the ENTEROFLOR Kiddy test are expressed in decimal logarithms of the number of genome equivalents of each group or individual microorganism in 1 gram of feces. For example, the value of 9.3 Lg(GE/g) is 10^9.3 GE/g.
The result of a microbiological culture is traditionally expressed in CFU/g, for example, 10^8 CFU/g.
The results of microbiological and molecular genetic tests may differ. The reasons for discrepancies are described in the answer to the question.

Metabolically active infant Bifidobacterium species contribute to reproduction of lactobacilli and their presence in the gut microbiome, as well as the activation of cellular immunity and lymphocytes that have an anti-inflammatory effect.
For children of 1-2 years old the assay estimates the proportion of metabolically active infant bifidobacteria and notes a possible decrease in the number of microorganisms of this group.
If metabolically active "adult" Bifidobacterium species dominate, they contribute to the activation of the humoral immunity and pro-inflammatory T17 response and create a risk of sensitization of the organism.
For children 1-2 years old the diversity of metabolically active infant bifidobacteria that contribute to the more complete assimilation of breast milk oligosaccharides, is also analyzed.

Bacteria of the Clostridia class are included both in gut normobiota and in the group of pathobionts. For example, the Clostridium leptum group of bacteria can account for up to 60% of the entire gut microbiota and be one of the leading representatives of the normobiota. These microorganisms produce substances useful for human organism, such as vitamins and essential aminoacids.
At the same time, the Clostridium difficile and Clostridium perfringens groups belong to the opportunistic microbiota and can cause dysbiotic conditions.
In microbiological culture only Clostridioides difficile is usually identified as potentially toxigenic. The rest of the Clostridia is not determined by standard sowing.

This is an absolute pathogen, which is included in the assay for the diagnostics of acute gastroenteritis.

Bacteria of the genera Eubacterium and Butyrivibrio are included in the family Lachnospiraceae.

Yes, information about the age of a child is important to form the correct conclusion because the composition of the microbiota in children depends on their age.

The diversity of gut microbiota depends on the age of a child. For example, for a 1-month-old infant normal diversity of microbiota is considered to be more than 3 taxa. By the age of 2, the diversity of gut microbiota must be at least 10 taxa.
Various groups of bacteria, involved in the digestion, begin to actively colonize the gut with the introduction of complementary foods (vegetables and fruits, milk and dairy-free porridge, meat puree, cottage cheese, eggs). Microorganisms of the normobiota have different mechanisms of pathobionts supression. Hence, the more the diversity, the more stable is gut biocenosis.
A decrease in gut microbial diversity usually indicates dysbiosis and may be accompanied by an increase in the proportion of opportunistic microbiota.