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

Manzanares, William

Lemieux, Margot

Langlois, Pascal L

Wischmeyer, Paul E

England

2016-11-06T18:04:13Z

2016-08-19

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.

http://www.ncbi.nlm.nih.gov/pubmed/27538711

10.1186/s13054-016-1434-y

1466-609X

https://hdl.handle.net/10161/12990

eng

Springer Science and Business Media LLC

Crit Care

10.1186/s13054-016-1434-y

Critical care

Infections

Probiotics

Synbiotics

Systematic review

Ventilator-associated pneumonia

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

Journal article

http://www.ncbi.nlm.nih.gov/pubmed/27538711

262

Anesthesiology

Anesthesiology, Critical Care Medicine

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

School of Medicine

Published online

19