Probiotics versus antibiotic decontamination of the digestive tract: infection and mortality

Abstract

PurposeSelective decontamination of the digestive tract (SDD) has been shown to decrease the infection rate and mortality in intensive care units (ICUs); Lactobacillus plantarum 299/299v plus fibre (LAB) has been used for infection prevention and does not harbour the potential disadvantages of antibiotics. The objective was to assess whether LAB is not inferior to SDD in infection prevention.MethodsTwo hundred fifty-four consecutive ICU patients with expected mechanical ventilation ≥48 h and/or expected ICU stay ≥72 h were assigned to receive SDD: four times daily an oral paste (polymyxin E, gentamicin, amphotericin B), enteral solution (same antibiotics), intravenous cefotaxime (first 4 days) or LAB: two times daily L. plantarum 299/299v with rose-hip.ResultsThe primary endpoint was infection rate. A difference <12% between both groups indicated non-inferiority of LAB. The trial was prematurely stopped after a study reporting increased mortality in critically ill pancreatitis patients receiving probiotics. No significant difference in infection rate [31% in the LAB group, 24% in the SDD group (OR 1.68, 95% CI 0.91–3.08; p = 0.10)] was found. ICU mortality was 26% and not significantly different between the LAB and SDD groups. Gram-positive cocci and Pseudomonas aeruginosa were significantly more frequently isolated from surveillance cultures in the SDD group compared to the LAB group (for sputum: 18 vs. 10% and 33 vs. 14%). Significantly more Enterobacteriaceae were found in the LAB group (23 vs. 50%). No increase in antibiotic resistance was found during and after SDD or LAB use.ConclusionsThe trial could not demonstrate the non-inferiority of LAB compared with SDD in infection prevention. Results suggest no increased ICU mortality risk in the LAB group.

Probiotics for preventing ventilator-associated pneumonia

“…The meta-analysis by Gu 2012 excluded two studies that were presented in this review (Spindler-Vesel 2007; Tan 2011), and included one study that was excluded from the present review (Oudhuis 2011). In this study the control group received selective decontamination of the digestive tract (SDD) using a four times daily regime comprising an oral paste (polymyxin E, gentamicin, amphotericin B), enteral solution (same antibiotics) and intravenous cefotaxime (first four days).…”

Probiotics or antibiotics: future challenges in medicine

“…Gentamicin resistance increased from 1.7 % in 1990 to 3 % in 2000, and ciprofloxacin resistance has been increasing from extremely low levels of less than l % to 5 % in 2000. S. aureus is the second most commonly reported bacteraemia (Ogunshe, 2008;Oudhuis et al, 2011). Resistance to meticillin, which indicates flucloxacillin resistance, has been significantly growing since the early 1990s (Dancer, 2008).…”

Year in review in Intensive Care Medicine 2011. II. Cardiovascular, infections, pneumonia and sepsis, critical care organization and outcome, education, ultrasonography, metabolism and coagulation

“…In a randomized trial in a Dutch ICU, SDD and probiotics were compared [30]. The probiotics contained Lactobacillus 299/299v plus fiber, administered two times daily.…”