Clinical Safety and Efficacy of Probiotic Administration Following Burn Injury

Abstract

Provision of probiotics has been limited postburn by questionable potential for bacterial translocation and risk of infection in an immune-compromised population. The purpose of this study was to evaluate the safety of probiotic administration in acutely burned, pediatric patients. Subjects were randomized to receive probiotic (n = 10) vs placebo (n = 10) twice daily. The investigational product was initiated within 10 days of burn, and daily supplementation continued until wound closure. Nursing staff was provided education regarding optimal procedures to minimize potential for study product cross contamination. Clinical outcomes (infection, antibiotic, antifungal, and operative days, tolerance, and mortality) were recorded. Length of stay was modified for burn size. Student's t-test, χ test, and nonparametric Wilcoxon's rank-sum test were used for comparative analysis. No differences were noted (probiotic; placebo) for age (7.1 ± 2.2; 6.9 ± 1.7), burn size (38.0 ± 5.9; 45.5 ± 4.45), full thickness (24.6 ± 5.6; 32.1 ± 5.4), postburn day admit (0.8 ± 0.4; 1.1 ± 0.4), or inhalation injury (10%; 20%). Infection days, antibiotic use, constipation, and emesis were similar between groups. Trends toward increased antifungal and laxative use as well as diarrhea incidence were evident in the controls (P < .30). Flatulence was statistically higher with probiotics. The control group trended toward higher requirement for excision/graft procedure. Medical length of stay was not significantly different between groups; however, time required to complete wound healing was shortened with probiotics. This study documents safety and provides preliminary efficacy data relative to probiotic supplementation postburn.

Microbiome‐skin‐brain axis: A novel paradigm for cutaneous wounds

“…The dual pathophysiological states of inflammation and an altered skin microbiome in chronic wounds suggest a therapeutic potential for anti‐inflammatory drugs and probiotics in ameliorating both the psychological and biochemical comorbidities associated with chronic wounds. Indeed, in limited studies, oral and topical probiotics have improved healing in animals and humans with burns and ulcers . One study in rats showed probiotic kefir extracts improved healing in P. aeruginosa ‐infected burns more effectively than silver sulfadiazine application .…”

Interleukin-22 Prevents Microbial Dysbiosis and Promotes Intestinal Barrier Regeneration Following Acute Injury

“…Enterobacteriaceae are able to out-compete normal commensal microbial species, specifically within the Firmicutes and Bacteroidetes phyla, and can perpetuate the effects of trauma and inflammation (33, 34). Research examining the efficacy of pre- and probiotics following burn injury has failed to show any significant benefits (35), which may be due to changes in the intestinal microenvironment following trauma that allow Gram-negative facultative bacteria to selectively outcompete beneficial commensal microbe colonization. The cause and consequence of Enterobacteriaceae overgrowth in our model remains to be established, and this will be the focus of future studies, as the relationship between the microbiome and intestine epithelial cells is highly important for homeostasis.…”

Nosocomial Infections in a Morocco Burn Unit

“…Inhalations of smokes are very rare in our patients. Nosocomial pneumopathies are, in general, a major cause of mortality and of morbidity in the burnt patients [9] [10]. They are highly linked to the initial severity of the burning and mostly supervene in burnt patients presenting lesions of inhalation and in those who underwent mechanical ventilation.…”