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Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis.

dc.contributor.author Manzanares, W
dc.contributor.author Lemieux, M
dc.contributor.author Langlois, PL
dc.contributor.author Wischmeyer, Paul Edmund
dc.coverage.spatial England
dc.date.accessioned 2016-11-06T18:04:13Z
dc.date.issued 2016-08-19
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/27538711
dc.identifier 10.1186/s13054-016-1434-y
dc.identifier.uri https://hdl.handle.net/10161/12990
dc.description.abstract BACKGROUND: Critical illness is characterized by a loss of commensal flora and an overgrowth of potentially pathogenic bacteria, leading to a high susceptibility to nosocomial infections. Probiotics are living non-pathogenic microorganisms, which may protect the gut barrier, attenuate pathogen overgrowth, decrease bacterial translocation and prevent infection. The purpose of this updated systematic review is to evaluate the overall efficacy of probiotics and synbiotic mixtures on clinical outcomes in critical illness. METHODS: Computerized databases from 1980 to 2016 were searched. Randomized controlled trials (RCT) evaluating clinical outcomes associated with probiotic therapy as a single strategy or in combination with prebiotic fiber (synbiotics). Overall number of new infections was the primary outcome; secondary outcomes included mortality, ICU and hospital length of stay (LOS), and diarrhea. Subgroup analyses were performed to elucidate the role of other key factors such as probiotic type and patient mortality risk on the effect of probiotics on outcomes. RESULTS: Thirty trials that enrolled 2972 patients were identified for analysis. Probiotics were associated with a significant reduction in infections (risk ratio 0.80, 95 % confidence interval (CI) 0.68, 0.95, P = 0.009; heterogeneity I (2) = 36 %, P = 0.09). Further, a significant reduction in the incidence of ventilator-associated pneumonia (VAP) was found (risk ratio 0.74, 95 % CI 0.61, 0. 90, P = 0.002; I (2) = 19 %). No effect on mortality, LOS or diarrhea was observed. Subgroup analysis indicated that the greatest improvement in the outcome of infections was in critically ill patients receiving probiotics alone versus synbiotic mixtures, although limited synbiotic trial data currently exists. CONCLUSION: Probiotics show promise in reducing infections, including VAP in critical illness. Currently, clinical heterogeneity and potential publication bias reduce strong clinical recommendations and indicate further high quality clinical trials are needed to conclusively prove these benefits.
dc.language eng
dc.relation.ispartof Crit Care
dc.relation.isversionof 10.1186/s13054-016-1434-y
dc.subject Critical care
dc.subject Infections
dc.subject Probiotics
dc.subject Synbiotics
dc.subject Systematic review
dc.subject Ventilator-associated pneumonia
dc.title Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis.
dc.type Journal article
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/27538711
pubs.begin-page 262
pubs.organisational-group Anesthesiology
pubs.organisational-group Anesthesiology, Critical Care Medicine
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group School of Medicine
pubs.publication-status Published online
pubs.volume 19
dc.identifier.eissn 1466-609X


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