Do probiotics help prevent ventilator-associated pneumonia in critically ill patients? A systematic review with meta-analysis

Abstract

BackgroundProbiotic treatments might contribute to the prevention of ventilation-associated pneumonia (VAP). Due to its unclear clinical effects, here we intend to assess the preventive effect and safety of probiotics on Intensive Care Unit (ICU) patients.MethodsEligible randomised controlled trials were selected in databases until 31 September 2019. The characteristics of the studies were extracted, including study design, definition of VAP, probiotics intervention, category of included patients, incidence of VAP, mortality, duration of mechanical ventilation(MV) and ICU stay. Heterogeneity was evaluated by Chi-square and I2 tests.Results15 studies involving 2039 patients were identified for analysis. The pooled analysis suggests significant reduction on VAP (RR, 0.68; 95%Cl, 0.60 to 0.77; p<0.00001) in a fixed effect model. And subgroup analysis was performed on category of clinical and microbiogical criteria both support the above conclusion. However, no significant difference in duration of MV or length of ICU stay in a random effect model. Also, no significant differences in total mortality, overall mortality, 28-day mortality, 90-day mortality were found in the fixed effect model.ConclusionsThe probiotics helped prevent VAP without impacting duration of mechanical ventilation, length of ICU stay, or mortality.

Clinical Benefits From Administering Probiotics to Mechanical Ventilated Patients in Intensive Care Unit: A PRISMA-Guided Meta-Analysis

“…However, our results demonstrated that the use of probiotics could reduce the length of ICU stay, duration of mechanical ventilation, and incidence of bacteria colonization. Compared with previous meta-analyses by Zhao et al (13) and Ji et al (12), the trials by Klarin et al (36) and Kotzampassi et al (37) were excluded in our meta-analysis because the patient cohorts of these two trials are the same as in Klarin et al (19) and Giamarellos-Bourboulis et al (29). Furthermore, our meta-analysis included the latest study by Johnstone et al (16), which enrolled more than 2,600 patients and was the largest randomized trial to date.…”

“…They can selectively modulate the growth of the microbiome, inhibit colonization with invasive pathogens, and improve the microecological balance of the host (9). Recent meta-analyses (10)(11)(12)(13) indicated that the administration of probiotics could significantly reduce the incidence of VAP. However, several studies have described the potential risks of probiotics such as systemic infections, deleterious metabolic activities, excessive immune stimulation in susceptible individuals, gene transfer, and gastrointestinal side effects (14,15).…”

Mucus, Microbiomes and Pulmonary Disease

“…Understanding how particular species-and/or strain-level functional differences in microbial interaction with host immunity may better explain disease status and reveal appropriate individually tailored targets. Dietary probiotics reduce the incidence of ventilator-associated pneumonia, without impacting the duration of mechanical ventilation, length of hospitalization, or mortality [133]. This raises important questions of a potential to partly restore "diseased" respiratory microbiomes using microbiota-directed or host-targeted therapies such as probiotics and/or metabolite supplementation.…”

The Role of Dysbiosis in Critically Ill Patients With COVID-19 and Acute Respiratory Distress Syndrome

“…Probiotics are living micro-organisms which confer benefits to the host when administrated in adequate dose, and most used organisms include bifidobacteria, lactic acid bacteria, enterococci, and yeast (139). Probiotics usually have distinctive characteristics such as the ability of surviving under intestinal conditions, stimulating the immune system and acting against pathogens, also preventing health-care associated pneumonia (140). Furthermore, probiotics exert interesting properties by modulating cytokines production, interacting with TLRs, antagonizing pathogens in cell adhesion and mucin homeostasis, and by stimulating SCFAs production (141).…”