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Nutr Clin Pract. 2019 Feb;34(1):156-162. doi: 10.1002/ncp.10191. Epub 2018 Aug 8.

Effect of a Probiotic Preparation on Ventilator-Associated Pneumonia in Critically Ill Patients Admitted to the Intensive Care Unit: A Prospective Double-Blind Randomized Controlled Trial.

Author information

1
Department of Anesthesiology, Fellowship of Critical Care Medicine, Evidence-Based Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
2
Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
3
Anesthesiology Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.
4
Department of Microbiology, Food and Drug Safety Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
5
Department of Nutrition, Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

BACKGROUND:

Ventilator-associated pneumonia (VAP) occurs as a life-threatening complication in critically ill mechanically ventilated patients. Probiotic administration may modify the gut microbiota; however, whether this modification could decrease VAP occurrence is not known.

METHODS:

In this study, 100 adult critically ill patients undergoing mechanical ventilation for >48 hours were randomly assigned to either the probiotic or the control group. The patients in the probiotic group received 2 capsules of probiotic preparation containing Lactobacillus, Bifidobacterium, and Streptococcus spp., and those in the control group received placebo daily for 14 days.

RESULTS:

The patients in the probiotic group had a lower incidence of statistically microbiologically confirmed VAP. The duration of intensive care unit (ICU) and hospital stay was also lower in the probiotic group (P < .05). More than half of the patients in the control group had gastric residuals during ICU stay, compared with only 30% of patients in the probiotic group (P = .004). Probiotic usage led to a nonsignificant decrease in diarrhea, gastric and oropharyngeal colonization, and incidence of multidrug-resistant pathogens. The Kaplan-Meier survival curves for time to the first episode of VAP did not show a significant difference between probiotic and control groups (log-rank test = 1.89; P = .17).

CONCLUSIONS:

The results of probiotic administration for the prevention of VAP remain inconclusive in this trial. However, such an approach can decrease the length of ICU and hospital stay. Well-designed multicenter clinical studies with defined combinations of probiotics and definite end points are necessary in this field.

KEYWORDS:

critical illness; intensive care unit; probiotics; ventilator-associated pneumonia

PMID:
30088841
DOI:
10.1002/ncp.10191
[Indexed for MEDLINE]

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