Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial
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To evaluate the potential preventive effect of probiotics on ventilator-associated pneumonia (VAP).
This was an open-label, randomized, controlled multicenter trial involving 235 critically ill adult patients who were expected to receive mechanical ventilation for ≥48 h. The patients were randomized to receive (1) a probiotics capsule containing live Bacillus subtilis and Enterococcus faecalis (Medilac-S) 0.5 g three times daily through a nasogastric feeding tube plus standard preventive strategies or (2) standard preventive strategies alone, for a maximum of 14 days. The development of VAP was evaluated daily, and throat swabs and gastric aspirate were cultured at baseline and once or twice weekly thereafter.
The incidence of microbiologically confirmed VAP in the probiotics group was significantly lower than that in the control patients (36.4 vs. 50.4 %, respectively; P = 0.031). The mean time to develop VAP was significantly longer in the probiotics group than in the control group (10.4 vs. 7.5 days, respectively; P = 0.022). The proportion of patients with acquisition of gastric colonization of potentially pathogenic microorganisms (PPMOs) was lower in the probiotics group (24 %) than the control group (44 %) (P = 0.004). However, the proportion of patients with eradication PPMO colonization on both sites of the oropharynx and stomach were not significantly different between the two groups. The administration of probiotics did not result in any improvement in the incidence of clinically suspected VAP, antimicrobial consumption, duration of mechanical ventilation, mortality and length of hospital stay.
Therapy with the probiotic bacteria B. Subtilis and E. faecalis are an effective and safe means for preventing VAP and the acquisition of PPMO colonization in the stomach.
KeywordsProbiotics Ventilator-associated pneumonia Prevention and control Gastric colonization
We thank Man Chen, Xin Qu, and Guo-qiang Qie from the Intensive Care Unit, Shandong Provincial Hospital affiliated to Shandong University, People’s Republic of China for advice and copy-editing. This clinical trial was funded by grants from the Specific Fund of Clinical Medical Research of the Chinese Medical Association (No: 10030180240) and from the National Natural Science Foundation of China (No: 81200238).
Compliance with ethical standards
Conflicts of interest
All authors declare that they have no conflict of interest regarding the submission and publication of the work reported here.
- 4.de Jonge E, Schultz MJ, Spanjaard L, Bossuyt PM, Vroom MB, Dankert J et al (2003) Effects of selective decontamination of the digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 362:1011–1016. doi: 10.1016/S0140-6736(03)14409-1 CrossRefPubMedGoogle Scholar
- 8.Zeng J, Li YQ, Zuo XL, Zhen YB, Yang J, Liu CH (2008) Clinical trial: effect of active lactic acid bacteria on mucosal barrier function in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 28:994–1002. doi: 10.1111/j.1365-2036.2008.03818.x CrossRefPubMedGoogle Scholar
- 16.Bergmans DCJJ, Bonten MJM, Gaillard CA, Paling JC, van der Geest S, van Tiel FH et al (2001) Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Am J Respir Crit Care Med 164:382–388. doi: 10.1164/ajrccm.164.3.2005003 CrossRefPubMedGoogle Scholar
- 18.Kotzampassi K, Giamarellos-Bourboulis EJ, Voudouris A, Kazamias P, Eleftheriadis E (2006) Benefits of a synbiotic formula (Synbiotic 2000Forte) in critically ill trauma patients: early results of a randomized controlled trial. World J Surg 30:1848–18455. doi: 10.1007/s00268-005-0653-1 CrossRefPubMedGoogle Scholar
- 20.Banupriya B, Biswal N, Srinivasaraghavan R, Narayanan P, Mandal J (2015) Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive Care Med 41:677–685. doi: 10.1007/s00134-015-3694-4 CrossRefPubMedGoogle Scholar
- 21.Forestier C, Guelon D, Cluytens V, Gillart T, Sirot J, De Champs C (2008) Oral probiotic and prevention of Pseudomonas aeruginosa infections: a randomized, double-blind, placebo controlled pilot study in intensive care unit patients. Crit Care 12:R69. doi: 10.1186/cc6907 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Knight DJ, Gardiner D, Banks A, Snape SE, Weston VC, Bengmark S et al (2009) 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 35:854–861. doi: 10.1007/s00134-008-1368-1 CrossRefPubMedGoogle Scholar
- 25.[No authors listed] (2015) Randomized controlled study of probiotics containing Lactobacillus casei (Shirota strain) for prevention of ventilator-associated pneumonia. J Med Assoc Thai 98:253–259Google Scholar
- 31.Scholte JB, van Dessel HA, Linssen CF, Bergmans DC, Savelkoul PH, Roekaerts PM et al (2014) Endotracheal aspirate and bronchoalveolar lavage fluid analysis: interchangeable diagnostic modalities in suspected ventilator-associated pneumonia? J Clin Microbiol 52:3597–3604. doi: 10.1128/JCM.01494-14 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Jain PK, McNaught CE, Anderson AD, MacFie J, Mitchell CJ (2004) Influence of synbiotic containing Lactobacillus acidophilus La5, Bifidobacterium lactis Bb 12, Streptococcus thermophilus, Lactobacillus bulgaricus and oligofructose on gut barrier function and sepsis in critically ill patients: a randomised controlled trial. Clin Nutr 23:467–475. doi: 10.1016/j.clnu.2003.12.002 CrossRefPubMedGoogle Scholar
- 38.Hashimoto S, Shime N (2013) Evaluation of semi-quantitative scoring of Gram staining or semi-quantitative culture for the diagnosis of ventilator-associated pneumonia: a retrospective comparison with quantitative culture. J Intensive Care 1:2. doi: 10.1186/2052-0492-1-2 CrossRefPubMedPubMedCentralGoogle Scholar