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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.

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



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.


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.


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).


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.


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

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