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Probiotic Prophylaxis of Nosocomial Pneumonia in Critically Ill Patients

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Diet and Nutrition in Critical Care

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Abstract

Nosocomial pneumonia is common and is associated with considerable morbidity and mortality. Some of the beneficial effects of probiotics appear to be associated with improvement in intestinal barrier function, restoration of normal intestinal permeability, modification of the balance of intestinal microbiota, and immunomodulation. Several experimental and clinical studies have suggested a promising effect of probiotics on the prevention of nosocomial pneumonia in critically ill patients. To date, clinical research concerning the effects of probiotics in critically ill patients has provided conflicting results. Large, well-designed, randomized, multicenter trials are needed to confirm the effects of probiotics in diverse populations of critically ill patients.

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Abbreviations

CI:

Confidence intervals

DCs:

Dendritic cells

ICU:

Intensive care unit

MODS:

Multiple organ dysfunction syndrome

MV:

Mechanical ventilation

NA:

Not available

NP:

Nosocomial pneumonia

OR:

Odds ratios

PPM:

Potentially pathogenic microorganisms

RCTs:

Randomized controlled trials

RR:

Relative risk

SDD:

Selective digestive tract decontamination

SOD:

Selective oropharyngeal decontamination

VAP:

Ventilator-associated pneumonia

References

  • Alvarez S, Herrero C, Bru E, Perdigon G. Effect of Lactobacillus casei and yogurt administration on prevention of Pseudomonas aeruginosa infection in young mice. J Food Prot. 2001;64(11):1768–74.

    CAS  PubMed  Google Scholar 

  • Alverdy JC, Laughlin RS, Wu L. Influence of the critically ill state on host-pathogen interactions within the intestine: gut-derived sepsis redefined. Crit Care Med. 2003;31(2):598–607.

    Article  PubMed  Google Scholar 

  • American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416.

    Article  Google Scholar 

  • Arribas B, Rodríguez-Cabezas ME, Comalada M, Bailón E, Camuesco D, Olivares M, Xaus J, Zarzuelo A, Gálvez J. Evaluation of the preventative effects exerted by Lactobacillus fermentum in an experimental model of septic shock induced in mice. Br J Nutr. 2009;101(1):51–8.

    Article  CAS  PubMed  Google Scholar 

  • Barraud D, Blard C, Hein F, Marcon O, Cravoisy A, Nace L, Alla F, Bollaert PE, Gibot S. Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial. Intensive Care Med. 2010;36(9):1540–7.

    Article  PubMed  Google Scholar 

  • Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, Nieuwenhuijs VB, Bollen TL, van Ramshorst B, Witteman BJ, Rosman C, Ploeg RJ, Brink MA, Schaapherder AF, Dejong CH, Wahab PJ, van Laarhoven CJ, van der Harst E, van Eijck CH, Cuesta MA, Akkermans LM, Gooszen HG, Dutch Acute Pancreatitis Study G. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;371(9613):651–9.

    Article  PubMed  Google Scholar 

  • Christensen HR, Frokiaer H, Pestka JJ. Lactobacilli differentially modulate expression of cytokines and maturation surface markers in murine dendritic cells. J Immunol. 2002;168(1):171–8.

    Article  CAS  PubMed  Google Scholar 

  • Crooks NH, Snaith C, Webster D, Gao F, Hawkey P. Clinical review: probiotics in critical care. Crit Care. 2012;16(6):237.

    Article  PubMed Central  Google Scholar 

  • Cross ML, Ganner A, Teilab D, Fray LM. Patterns of cytokine induction by gram-positive and gram-negative probiotic bacteria. FEMS Immunol Med Microbiol. 2004;42(2):173–80.

    Article  CAS  PubMed  Google Scholar 

  • Cunningham-Rundles S, Ahrne S, Johann-Liang R, Abuav R, Dunn-Navarra AM, Grassey C, Bengmark S, Cervia JS. Effect of probiotic bacteria on microbial host defense, growth, and immune function in human immunodeficiency virus type-1 infection. Nutrients. 2011;3(12):1042–70.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • De Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJ, Bernards AT, Kuijper EJ, Joore JC, Leverstein-van Hall MA, Bindels AJ, Jansz AR, Wesselink RM, de Jongh BM, Dennesen PJ, van Asselt GJ, te Velde LF, Frenay IH, Kaasjager K, Bosch FH, van Iterson M, Thijsen SF, Kluge GH, Pauw W, de Vries JW, Kaan JA, Arends JP, Aarts LP, Sturm PD, Harinck HI, Voss A, Uijtendaal EV, Blok HE, Thieme Groen ES, Pouw ME, Kalkman CJ, Bonten MJ. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009;360:20–31.

    Article  PubMed  Google Scholar 

  • Doig CJ, Sutherland LR, Sandham JD, Fick GH, Verhoef M, Meddings JB. Increased intestinal permeability is associated with the development of multiple organ dysfunction syndrome in critically ill ICU patients. Am J Respir Crit Care Med. 1998;158(2):444–51.

    Article  CAS  PubMed  Google Scholar 

  • Flynn S, van Sinderen D, Thornton GM, Holo H, Nes IF, Collins JK. Characterization of the genetic locus responsible for the production of ABP-118, a novel bacteriocin produced by the probiotic bacterium Lactobacillus salivarius subsp. salivarius UCC118. Microbiology. 2002;148:973–84.

    CAS  PubMed  Google Scholar 

  • Forestier C, Guelon D, Cluytens V, Gillart T, Sirot J, De Champs C. Oral probiotic and prevention of Pseudomonas aeruginosa infections: a randomized, double-blind, placebo-controlled pilot study in intensive care unit patients. Crit Care. 2008;12(3):R69.

    Article  PubMed Central  PubMed  Google Scholar 

  • Giamarellos-Bourboulis EJ, Bengmark S, Kanellakopoulou K, Kotzampassi K. Pro- and synbiotics to control inflammation and infection in patients with multiple injuries. J Trauma. 2009;67(4):815–21.

    Article  PubMed  Google Scholar 

  • Gibson GR, Probert HM, Loo JV, Rastall RA, Roberfroid MB. Dietary modulation of the human colonic microbiota: updating the concept of prebiotics. Nutr Res Rev. 2004;17(2):259–75.

    Article  CAS  PubMed  Google Scholar 

  • Goldin BR, Gorbach SL. Clinical indications for probiotics: an overview. Clin Infect Dis. 2008;46:S96–100.

    Article  PubMed  Google Scholar 

  • Gu WJ, Wei CY, Yin RX. Lack of efficacy of probiotics in preventing ventilator-associated pneumonia probiotics for ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. Chest. 2012;142(4):859–68.

    Article  PubMed  Google Scholar 

  • Guarner F, Khan AG, Garisch J, Eliakim R, Gangl A, Thomson A, Krabshuis J, Lemair T, Kaufmann P, de Paula JA, Fedorak R, Shanahan F, Sanders ME, Szajewska H, Ramakrishna BS, Karakan T, Kim N, World Gastroenterology Organization. World gastroenterology organisation global guidelines: probiotics and prebiotics October 2011. J Clin Gastroenterol. 2012;46(6):468–81.

    Article  PubMed  Google Scholar 

  • Haller D, Bode C, Hammes WP, Pfeifer AM, Schiffrin EJ, Blum S. Non-pathogenic bacteria elicit a differential cytokine response by intestinal epithelial cell/leucocyte co-cultures. Gut. 2000;47(1):79–87.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Hart AL, Lammers K, Brigidi P, Vitali B, Rizzello F, Gionchetti P, Campieri M, Kamm MA, Knight SC, Stagg AJ. Modulation of human dendritic cell phenotype and function by probiotic bacteria. Gut. 2004;53(11):1602–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Inglis TJ, Sherratt MJ, Sproat LJ, Gibson JS, Hawkey PM. Gastroduodenal dysfunction and bacterial colonisation of the ventilated lung. Lancet. 1993;341(8850):911–3.

    Article  CAS  PubMed  Google Scholar 

  • Kanazawa H, Nagino M, Kamiya S, Komatsu S, Mayumi T, Takagi K, Asahara T, Nomoto K, Tanaka R, Nimura Y. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg/Dtsch Ges Chir. 2005;390(2):104–13.

    Article  Google Scholar 

  • Knight DJ, Gardiner D, Banks A, Snape SE, Weston VC, Bengmark S, Girling KJ. Effect of synbiotic therapy on the incidence of ventilator associated pneumonia in critically ill patients: a randomised, double-blind, placebo-controlled trial. Intensive Care Med. 2009;35(5):854–61.

    Article  PubMed  Google Scholar 

  • Kotzampassi K, Giamarellos-Bourboulis EJ. Probiotics for infectious diseases: more drugs, less dietary supplementation. Int J Antimicrob Agents. 2012;40:288–96.

    Article  CAS  PubMed  Google Scholar 

  • Lievin-Le Moal V, Servin AL. The front line of enteric host defense against unwelcome intrusion of harmful microorganisms: mucins, antimicrobial peptides, and microbiota. Clin Microbiol Rev. 2006;19(2):315–37.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Liu KX, Zhu YG, Zhang J, Tao LL, Lee JW, Wang XD, Qu JM. Probiotics’ effects on the incidence of nosocomial pneumonia in critically ill patients: a systematic review and meta-analysis. Crit Care. 2012;16(3):R109.

    Article  PubMed Central  PubMed  Google Scholar 

  • MacFie J, O’Boyle C, Mitchell CJ, Buckley PM, Johnstone D, Sudworth P. Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity. Gut. 1999;45:223–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Mack DR, Ahrne S, Hyde L, Wei S, Hollingsworth MA. Extracellular MUC3 mucin secretion follows adherence of Lactobacillus strains to intestinal epithelial cells in vitro. Gut. 2003;52(6):827–33.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Macpherson AJ, Uhr T. Induction of protective IgA by intestinal dendritic cells carrying commensal bacteria. Science. 2004;303(5664):1662–5.

    Article  CAS  PubMed  Google Scholar 

  • Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am J Respir Crit Care Med. 2010;182(8):1058–64.

    Article  PubMed Central  PubMed  Google Scholar 

  • Ogawa M, Shimizu K, Nomoto K, Tanaka R, Hamabata T, Yamasaki S, Takeda T, Takeda Y. Inhibition of in vitro growth of Shiga toxin-producing Escherichia coli O157:H7 by probiotic Lactobacillus strains due to production of lactic acid. Int J Food Microbiol. 2001;68(1–2):135–40.

    Article  CAS  PubMed  Google Scholar 

  • Oostdijk EA, de Smet AM, Blok HE, Thieme Groen ES, van Asselt GJ, Benus RF, Bernards SA, Frenay IH, Jansz AR, de Jongh BM, Kaan JA, Leverstein-van Hall MA, Mascini EM, Pauw W, Sturm PD, Thijsen SF, Kluytmans JA, Bonten MJ. Ecological effects of selective decontamination on resistant gram-negative bacterial colonization. Am J Respir Crit Care Med. 2010;181(5):452–7.

    Article  PubMed  Google Scholar 

  • Otte JM, Podolsky DK. Functional modulation of enterocytes by gram-positive and gram-negative microorganisms. Am J Physiol Gastrointest Liver Physiol. 2004;286(4):G613–26.

    Article  CAS  PubMed  Google Scholar 

  • Patel RM, Myers LS, Kurundkar AR, Maheshwari A, Nusrat A, Lin PW. Probiotic bacteria induce maturation of intestinal claudin 3 expression and barrier function. Am J Pathol. 2012;180(2):626–35.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Petrof EO, Dhaliwal R, Manzanares W, Johnstone J, Cook D, Heyland DK. Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med. 2012;40(12):3290–302.

    Article  PubMed  Google Scholar 

  • Rayes N, Hansen S, Seehofer D, Muller AR, Serke S, Bengmark S, Neuhaus P. Early enteral supply of fiber and Lactobacilli versus conventional nutrition: a controlled trial in patients with major abdominal surgery. Nutrition. 2002;18(7–8):609–15.

    Article  PubMed  Google Scholar 

  • Rayes N, Seehofer D, Theruvath T, Schiller RA, Langrehr JM, Jonas S, Bengmark S, Neuhaus P. Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation-a randomized, double-blind trial. Am J Transplant. 2005;5(1):125–30.

    Article  PubMed  Google Scholar 

  • Rayes N, Seehofer D, Theruvath T, Mogl M, Langrehr JM, Nussler NC, Bengmark S, Neuhaus P. Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind trial. Ann Surg. 2007;246(1):36–41.

    Article  PubMed Central  PubMed  Google Scholar 

  • Resta-Lenert S, Barrett KE. Live probiotics protect intestinal epithelial cells from the effects of infection with enteroinvasive Escherichia coli (EIEC). Gut. 2003;52(7):988–97.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Romeo MG, Romeo DM, Trovato L, Oliveri S, Palermo F, Cota F, Betta P. Role of probiotics in the prevention of the enteric colonization by Candida in preterm newborns: incidence of late-onset sepsis and neurological outcome. J Perinatol. 2011;31(1):63–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Salminen MK, Rautelin H, Tynkkynen S, Poussa T, Saxelin M, Valtonen V, Jarvinen A. Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG. Clin Infect Dis. 2004;38(1):62–9.

    Article  PubMed  Google Scholar 

  • Sanders ME, Guarner F, Guerrant R, Holt PR, Quigley EM, Sartor RB, Sherman PM, Mayer EA. An update on the use and investigation of probiotics in health and disease. Gut. 2013;62(5):787–96.

    Article  CAS  PubMed  Google Scholar 

  • Sherman PM, Ossa JC, Johnson-Henry K. Unraveling mechanisms of action of probiotics. Nutr Clin Pract. 2009;24:10–4.

    Article  PubMed  Google Scholar 

  • Snydman DR. The safety of probiotics. Clin Infect Dis. 2008;46 Suppl 2:S104–11.

    Article  PubMed  Google Scholar 

  • Spindler-Vesel A, Bengmark S, Vovk I, Cerovic O, Kompan L. Synbiotics, prebiotics, glutamine, or peptide in early enteral nutrition: a randomized study in trauma patients. J Parenter Enteral Nutr. 2007;31(2):119–26.

    Article  CAS  Google Scholar 

  • Tan M, Zhu JC, Du J, Zhang LM, Yin HH. Effects of probiotics on serum levels of Th1/Th2 cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study. Critical Care 2011;15:R290.

    Article  PubMed Central  PubMed  Google Scholar 

  • Theodorakopoulou M, Perros E, Giamarellos-Bourboulis EJ, Dimopoulos G. Controversies in the management of the critically ill: the role of probiotics. Int J Antimicrob Agents. 2013;42:S41–4.

    Article  CAS  PubMed  Google Scholar 

  • Torres A, Ewig S, Lode H, Carlet J. Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med. 2009;35:9–29.

    Article  PubMed  Google Scholar 

  • Vesterlund S, Karp M, Salminen S, Ouwehand AC. Staphylococcus aureus adheres to human intestinal mucus but can be displaced by certain lactic acid bacteria. Microbiology 2006;152(Pt 6):1819–26.

    Article  CAS  PubMed  Google Scholar 

  • Villena J, Racedo S, Agüero G, Bru E, Medina M, Alvarez S. Lactobacillus casei improves resistance to pneumococcal respiratory infection in malnourished mice. J Nutr. 2005;135(6):1462–9.

    CAS  PubMed  Google Scholar 

  • Villena J, Barbieri N, Salva S, Herrera M, Alvarez S. Enhanced immune response to pneumococcal infection in malnourished mice nasally treated with heat-killed Lactobacillus casei. Microbiol Immunol. 2009;53(11):636–46.

    Article  CAS  PubMed  Google Scholar 

  • Vincent JL. Nosocomial infections in adult intensive-care units. Lancet. 2003;361(9374):2068–77.

    Article  PubMed  Google Scholar 

  • Wagner RD, Pierson C, Warner T, et al. Biotherapeutic effects of probiotic bacteria on candidiasis in immunodeficient mice. Infect Immun. 1997;65:4165–72.

    CAS  PubMed Central  PubMed  Google Scholar 

  • Wang J, Liu KX, Ariani F, Tao LL, Zhang J, Qu JM. Probiotics for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of high-quality randomized controlled trials. PLoS One. 2013;8(12):e83934.

    Article  PubMed Central  PubMed  Google Scholar 

  • Zhou JS, Pillidge CJ, Gopal PK, Gill HS. Antibiotic susceptibility profiles of new probiotic Lactobacillus and Bifidobacterium strains. Int J Food Microbiol. 2005;98(2):211–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pulmonary Medicine, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, China

    Kai-xiong Liu & Qi-chang Lin

  2. Department of Pulmonary Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, 221 Yananxi Road, 200040, Shanghai, China

    Jie-ming Qu

  3. Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China

    Jing Zhang

Authors
  1. Kai-xiong Liu
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  2. Jie-ming Qu
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  3. Jing Zhang
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  4. Qi-chang Lin
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Correspondence to Jie-ming Qu .

Editor information

Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Liu, Kx., Qu, Jm., Zhang, J., Lin, Qc. (2014). Probiotic Prophylaxis of Nosocomial Pneumonia in Critically Ill Patients. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_153-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_153-1

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