Probiotics in the critically ill

Petrof, Elaine O.; Dhaliwal, Rupinder; Manzanares, William; Johnstone, Jennie; Cook, Deborah J.; Heyland, Daren K.

doi:10.1097/ccm.0b013e318260cc33

Cited by 119 publications

(59 citation statements)

References 92 publications

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“…The main findings of our review were in agreement with the recent previous meta-analyses by Siempos 2010 and Petrof 2012, but contradict the results of another meta-analysis on the same topic (Gu 2012). The meta-analysis by Siempos 2010 included five studies with a total of 689 participants.…”

Section: Discussionsupporting

confidence: 75%

“…Their results showed that probiotics appeared to be associated with a lower incidence of VAP. The meta-analysis by Petrof 2012 included 23 studies with a total of 2153 participants and indicated, again, that lower VAP incidence was associated with people receiving probiotics. The meta-analysis by Gu 2012 included seven studies with a total of 1142 participants and indicated that probiotics show no benefit in VAP prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

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Probiotics for preventing ventilator-associated pneumonia

Tao

et al. 2014

Cochrane Database of Systematic Reviews

122

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Probiotics for preventing ventilator-associated pneumonia

Tao

et al. 2014

Cochrane Database of Systematic Reviews

122

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“…However, when exclusively higher-quality trials were pooled, the favorable outcomes disappeared. Contrariwise, the beneficial effects were obvious in trials with an inherent high risk of bias [8]. In the same line, the present study by Zeng et al seems to be yet another non-blinded trial reporting tight statistical significance (p = 0.03).…”

supporting

confidence: 73%

“…This study adds to the existing literature summarized in a meta-analysis that demonstrated an overall reduction in infectious complications and VAP [8]. However, when exclusively higher-quality trials were pooled, the favorable outcomes disappeared.…”

mentioning

confidence: 51%

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Evidence in the eye of the beholder: about probiotics and VAP prevention

2016

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Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients

Johnstone¹,

Meade²,

Lauzier³

et al. 2021

JAMA

Self Cite

121

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for the Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT) Investigators and the Canadian Critical Care Trials Group IMPORTANCE Growing interest in microbial dysbiosis during critical illness has raised questions about the therapeutic potential of microbiome modification with probiotics. Prior randomized trials in this population suggest that probiotics reduce infection, particularly ventilator-associated pneumonia (VAP), although probiotic-associated infections have also been reported.OBJECTIVE To evaluate the effect of Lactobacillus rhamnosus GG on preventing VAP, additional infections, and other clinically important outcomes in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Randomized placebo-controlled trial in 44 ICUs in Canada, the United States, and Saudi Arabia enrolling adults predicted to require mechanical ventilation for at least 72 hours. A total of 2653 patients were enrolled from October 2013 to March 2019 (final follow-up, October 2020). INTERVENTIONS Enteral L rhamnosus GG (1 × 10 10 colony-forming units) (n = 1321) or placebo (n = 1332) twice daily in the ICU. MAIN OUTCOMES AND MEASURES The primary outcome was VAP determined by duplicate blinded central adjudication. Secondary outcomes were other ICU-acquired infections including Clostridioides difficile infection, diarrhea, antimicrobial use, ICU and hospital length of stay, and mortality. RESULTS Among 2653 randomized patients (mean age, 59.8 years [SD], 16.5 years), 2650 (99.9%) completed the trial (mean age, 59.8 years [SD], 16.5 years; 1063 women [40.1%.]with a mean Acute Physiology and Chronic Health Evaluation II score of 22.0 (SD, 7.8) and received the study product for a median of 9 days (IQR, 5-15 days). VAP developed among 289 of 1318 patients (21.9%) receiving probiotics vs 284 of 1332 controls (21.3%; hazard ratio [HR], 1.03 (95% CI, 0.87-1.22; P = .73, absolute difference, 0.6%, 95% CI, -2.5% to 3.7%). None of the 20 prespecified secondary outcomes, including other ICU-acquired infections, diarrhea, antimicrobial use, mortality, or length of stay showed a significant difference. Fifteen patients (1.1%) receiving probiotics vs 1 (0.1%) in the control group experienced the adverse event of L rhamnosus in a sterile site or the sole or predominant organism in a nonsterile site (odds ratio, 14.02; 95% CI, 1.79-109.58; P < .001).CONCLUSIONS AND RELEVANCE Among critically ill patients requiring mechanical ventilation, administration of the probiotic L rhamnosus GG compared with placebo, resulted in no significant difference in the development of ventilator-associated pneumonia. These findings do not support the use of L rhamnosus GG in critically ill patients.

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Probiotics in the critically ill

Cited by 119 publications

References 92 publications

Probiotics for preventing ventilator-associated pneumonia

Probiotics for preventing ventilator-associated pneumonia

Evidence in the eye of the beholder: about probiotics and VAP prevention

Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients

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