Decrease in Frequency of Liquid Stool in Enterally Fed Critically Ill Patients Given the Multispecies Probiotic VSL#3: A Pilot Trial

Abstract

Background Diarrhea has adverse consequences for critically ill patients, health care staff, and health care costs. Objective To evaluate the efficacy of the multispecies probiotic VSL#3 in reducing the mean number of episodes of liquid stool in enterally fed critically ill patients. Methods A single-center, double-blind, randomized, placebo-controlled pilot study was done in a 6-bed intensive care unit in a 330-bed public hospital in Australia. A total of 45 adults (20 intervention, 25 control) who required enteral nutrition for more than 72 hours were given VSL#3 or a placebo twice daily. The frequency (mean number of episodes per patient per day) and weight (grams per day) were determined for both liquid stool and liquid and loose (unformed) stool. Results The 2 groups of patients had no demographic or clinical differences. Patients received enteral nutrition for a mean of 8.5 days (SD, 5.4) and were studied for a mean of 11.9 days (SD, 5.6). Compared with the control group, the intervention group had a significant reduction in the frequency of liquid stools (incidence rate ratio, 0.50; 95% confidence interval, 0.27 to 0.93; P = .03). Smaller but still significant differences also occurred between the groups in both the frequency of episodes and the weight of liquid and loose (unformed) stool. Conclusion VSL#3 was effective in reducing the frequency of liquid stool in critically ill patients receiving enteral nutrition. Probiotics possibly can minimize diarrhea in critically ill tube-fed patients, but more controlled clinical trials are needed.

Microbial cell preparation in enteral feeding in critically ill patients: A randomized, double-blind, placebo-controlled clinical trial

“…They may exert their effects via immunomodulation [23], by suppressing the growth of enteropathogens via the production of bacteriocins, [6] competing for nutrients and adhesion sites on the intestinal wall [24,25] preventing translocation of bacteria out from the intestinal lumen via its action on tight junctions [26].…”

“…Replenishing the altered ecosystem of the gut with MCP may prove beneficial to reestablish the favorable homeostatic environment in the gastrointestinal tract [6,10]. Slow bowel movements are common in ICU patients with an estimated 80% of patients having no bowel movements in the first 72 hours of admission [9].…”

“…Furthermore, bacterial strains, such as Lactobacillus and Bifidobacterium are defined as preparations of microorganisms that exert therapeutic effects when administered in specific recommended dosages [6]. They can colonize the human intestine and modulate the gut ecosystem, which serves as a defense mechanism hindering the growth and colonization of pathogenic bacteria.…”

Treatment of amphibians infected with chytrid fungus: learning from failed trials with itraconazole, antimicrobial peptides, bacteria, and heat therapy

“…Although anti-Bd microbiota were previously shown to provide prophylactic benefits to R. muscosa and other amphibians (Harris et al 2009, Becker & Harris 2010, treatment of heavily infected frogs may require more frequent antifungal treatment or more persistent and strongly protective skin microbes. Probiotic treatments of human and veterinary diseases, as well as applications in agriculture and aquaculture, are often applied continuously or in pulses for the greatest benefit (Yang et al 2001, Nikoskelainen et al 2003, Frohmader et al 2010, Magnadottir 2010, Thomas & Greer 2010. Thus, a future research focus on prophylactic rather than remedial disease treatment may be warranted.…”

Mechanisms and effectiveness of prebiotics in modifying the gastrointestinal microbiota for the management of digestive disorders

“…Given the disappointing results for use of prebiotics in patients receiving EN, a contrasting approach is the use of probiotics, some strains of which are efficacious in the prevention of C. difficile-associated diarrhoea (45,46) . At least six randomised controlled trials of probiotics in prevention or treatment of diarrhoea in EN have been undertaken (47) , but only two have shown a beneficial effect in preventing diarrhoea, for Saccharomyces boulardii (48) and VSL#3 (49) both in the intensive care setting. Some researchers and clinicians have raised concerns about the safety of probiotics in such patient groups.…”