Use of probiotics to prevent ventilator-associated pneumonia: A survey of pharmacists' attitudes

Wheeler, Kathleen E.; Cook, Deborah J.; Mehta, Sangeeta; Calce, Adriana; Guenette, Melanie; Perreault, Marc M.; Thiboutot, Zoé; Duffett, Mark; Burry, Lisa

doi:10.1016/j.jcrc.2015.10.016

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…Our current systematic review demonstrates a significant treatment effect of probiotics in reducing VAP and did not demonstrate statistical heterogeneity, strengthening the signal that this may be an effective therapy for VAP. Recently, a Canadian survey [ 27 ] on the use of probiotics as a prophylactic strategy for VAP showed that most Canadian ICU pharmacists have used probiotics at least once, although they do not routinely recommend probiotics for the prevention of VAP.…”

Section: Discussionmentioning

confidence: 99%

“…Further, to date, no recent meta-analysis has examined the effect of probiotic versus synbiotic (probiotic and prebiotic fiber) therapy. Finally, a Canadian survey [ 27 ] on the use of probiotics as a prophylactic strategy for VAP showed that most Canadian ICU pharmacists have used probiotics at least once, although routine use is considered controversial and considerable practice variability exists. Thus, any increased understanding that the newly published trials can yield will be vital to clarifying clinical probiotic use in the ICU and areas in need of future research focus.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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BackgroundCritical 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.MethodsComputerized 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.ResultsThirty 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 I2 = 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; I2 = 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.ConclusionProbiotics 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…A recent meta-analysis of pro-biotics in intensive care patients suggested that administration of these organisms to either the oropharynx or GI tract could reduce development of VAP [98]; however, this approach has not yet found widespread acceptance [99]. Further work in this area would provide vital testing of the mechanistic hypothesis that dysbiosis plays a causative role in adverse outcomes in our patients.…”

Section: Reducing Harm: the Research Agendamentioning

confidence: 99%

Antimicrobial-associated harm in critical care: a narrative review

et al. 2020

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The belief that, for the individual patient, the benefit of prompt and continued use of antimicrobials outweighs any potential harm is a significant barrier to improved stewardship of these vital agents. Antimicrobial stewardship may be perceived as utilitarian rationing, seeking to preserve the availability of effective antimicrobials by limiting the development of resistance in a manner which could conflict with the immediate treatment of the patient in need. This view does not account for the growing evidence of antimicrobial-associated harm to individual patients. This review sets out the evidence for antimicrobial-associated harm and how this should be balanced with the need for prompt and appropriate therapy in infection. It describes the mechanisms by which antimicrobials may harm patients including: mitochondrial toxicity; immune cell toxicity; adverse drug reactions; selection of resistant organisms within a given patient; and disruption of the microbiome. Finally, the article indicates how the harms of antimicrobials may be mitigated and identifies areas for research and development in this field.

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“…The uncertain efficacy and safety of probiotics have restricted the clinical use of probiotics in intensive care units (ICUs), and most ICU pharmacists would not currently recommend probiotics for the prevention of ventilatorassociated pneumonia. 57 Hence, further clinical and experimental studies are strongly needed to accurately determine suitable probiotic organisms, optimal dose, timing of administration, duration of treatment, and safety.…”

Section: Figurementioning

confidence: 99%

Probiotics Prevent Candida Colonization and Invasive Fungal Sepsis in Preterm Neonates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhang

et al. 2017

Pediatrics & Neonatology

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To investigate whether probiotic supplementation could reduce the risk of fungal infection in preterm neonates in neonatal intensive care units (NICUs), we systematically searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) focusing on the effect of probiotics on fungal infection in preterm neonates. The outcomes of interest were Candida colonization and invasive fungal sepsis. Seven trials involving 1371 preterm neonates were included. Meta-analysis (fixed-effects model) showed that probiotic supplementation was significantly associated with a lower risk of Candida colonization (2 RCTs, n = 329; relative risk (RR), 0.43; 95% confidence interval (CI), 0.27-0.67; p = 0.0002; I = 0%), and invasive fungal sepsis (7 RCTs, n = 1371; RR, 0.64; 95% CI, 0.46-0.88; p = 0.006; I = 13%). After excluding one study with a high baseline incidence (75%) of fungal sepsis, the effect of probiotics on invasive fungal sepsis became statistically insignificant (RR, 0.88; 95% CI, 0.44-1.78; p = 0.72; I = 15%). When using the random-effects model, the effect of probiotics remained favorable for Candida colonization (RR, 0.43; 95% CI 0.27-0.68; p = 0.0002; I = 0%) but not for fungal sepsis (RR, 0.64; 95% CI 0.38-1.08; p = 0.10; I = 13%). Current evidence indicates that probiotics can reduce the risk of Candida colonization in preterm neonates in NICUs. Limited data support that probiotic supplementation prevents invasive fungal sepsis in preterm neonates. High-quality and adequately powered RCTs are warranted.

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Use of probiotics to prevent ventilator-associated pneumonia: A survey of pharmacists' attitudes

Cited by 8 publications

References 23 publications

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

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

Antimicrobial-associated harm in critical care: a narrative review

Probiotics Prevent Candida Colonization and Invasive Fungal Sepsis in Preterm Neonates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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