Probiotics

Indications

Prevention of Ventilator-Associated Pneumonia (VAP) (see Ventilator-Associated Pneumonia, Ventilator-Associated Pneumonia)

  • Clinical Efficacy: data are conflicting as to the effect of probiotics on the VAP rate
    • Systematic Review of Probiotics in Critically Ill Patients (Crit Care Med, 2012) [MEDLINE]
      • Probiotics Decreased Infectious Complications: including ventilator-associated pneumonia (VAP)
      • Probiotics Demonstrated a Trend Toward a Decreased ICU Mortality Rate, But Did Not Impact the Hospital Mortality rate
      • Probiotics Did Not Impact ICU/Hospital Length of Stay
    • Systematic Review and Meta-Analysis of the Effect of Probiotics in VAP Prevention (Chest, 2012) [MEDLINE]
      • Probiotics Did Not Impact the VAP Rate: however, there was significant heterogeneity between the studies –> further investigation is required
    • Systematic Review and Meta-Analysis of the Effect of Probiotics on Nosocomial Pneumonia in Critically Ill Patients (Crit Care, 2012) [MEDLINE]
      • Probiotics Decreased the Rate of Nosocomial Pneumonia in Critically Ill Patients: howeve, further trials are required to examine mortality and other endpoints
    • Meta-Analysis of Probiotics in Critically Ill Patients (Chest, 2013) [MEDLINE]
      • Probiotics Decreased ICU-Acquired Pneumonia Rates
      • Probiotics Decreased ICU Length of Stay
      • Probiotics Did Not Impact ICU/Hospital Mortality Rates

Prevention of Clostridium Difficile Infection (see Clostridium Difficile, Clostridium Difficile)

  • Clinical Efficacy
    • Review of Role of Probiotics in the Prevention of Clostridium Difficile Infection (Clin Infect Dis, 2015) [MEDLINE]
    • Data Conflict with Regard to the Efficacy of Probiotics in the Prevention of Clostridium Difficile Infection

Agents

  • Lactobacillus
  • Saccharomyces Boulardii
  • xxxx

Adverse Effects

Gastrointestinal Adverse Effects

Intestinal Ischemia (see Acute Mesenteric Ischemia, Acute Mesenteric Ischemia)

  • Epidemiology
    • Has Been Associated with the Use of Probiotics in the Setting of Acute Pancreatitis
    • Associated with Increased Mortality Rate

Infectious Adverse Effects

Bacteremia/Fungemia

  • Epidemiology
    • Small Number of Cases Have Been Reported with the Use of Probiotics: although none reported in clinical trials of probiotics
    • Probiotics Most Commonly Associated
      • Lactobacillus Rhamnosus GG
      • Sachharomyces Boulardii
    • Most Cases were Immunocompromised, Had Severe Comorbidities, Had Recent Surgery, and/or Had Prolonged Hospitalization
    • Two Cases of Sachharomyces Boulardii Fungemia Have Been Reported in Patients Who Were Not Receiving this Probiotic, But Acquired it Via Transmission from a Healthcare Worker Caring for a Patient Who was Taking Sachharomyces Boulardii

References

  • Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med. 2012 Dec;40(12):3290-302. doi: 10.1097/CCM.0b013e318260cc33 [MEDLINE]
  • Lack of efficacy of probiotics in preventing ventilator-associated pneumonia probiotics for ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. Chest. 2012 Oct;142(4):859-68 [MEDLINE]
  • Probiotics’ effects on the incidence of nosocomial pneumonia in critically ill patients: a systematic review and meta-analysis. Crit Care. 2012 Jun 25;16(3):R109. doi: 10.1186/cc11398 [MEDLINE]
  • Impact of the administration of probiotics on mortality in critically ill adult patients: a meta-analysis of randomized controlled trials. Chest. 2013 Mar;143(3):646-55. doi: 10.1378/chest.12-1745 [MEDLINE]