Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials

Abstract

Background Advances in surgery have considerably lowered postoperative morbidity. However, infection remains a considerable morbidity factor. The aim of this review is to identify the potential benefit(s) of the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery. Methods We searched PubMed, Scopus, Web of Science, and Cochrane library to identify randomized controlled trials (RCTs) that studied the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery. Results Nine RCTs studying 733 patients were included in our review. The incidence of postoperative pneumonia, cholangitis, and any infections as well as the duration of postoperative hospital stay and length of antibiotic therapy were lower among patients receiving probiotics than in the control group [six RCTs, 355 patients, odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09-0.68; three RCTs, 209 patients, OR0.18, 95% CI0.05-0.57; seven RCTs, 514 patients, OR 0.26, 95% CI 0.12-0.55; five RCTs, 313 patients, OR −2.70, 95% CI−5.15 to −0.25; four RCTs, 250 patients, OR −4.01, 95% CI−5.11 to −2.92, respectively], while the incidence of postoperative wound infection, urinary tract infection, intra-abdominal abscess, and mortality was not different between patients of the compared groups (six RCTs, 355 patients, OR0.52, 95% CI0.23-1.18; five RCTs, 313 patients, OR0.44, 95% CI0. four RCTs, 226 patients, OR0.44, nine RCTs, 685 patients, OR0.98, respectively). Conclusion The use of probiotics/synbiotics may reduce postoperative infections after abdominal surgery. This is a promising infection-preventive measure that may decrease morbidity, length of antibiotic therapy, duration of hospital stay, and pressure for emergence of antimicrobial resistance. However, the results of this meta-analysis should be interpreted with caution due to the significant heterogeneity of the studies included.

Probiotic Prophylaxis of Ventilator-associated Pneumonia

“…Studies enrolling adult trauma, neurosurgical, liver transplant, and general surgery patients have demonstrated trends toward reduced rates of infections, including pneumonia, in patients treated with probiotics (23)(24)(25)(26)(27). However, almost all of these studies included coadministration of prebiotics (nondigestible ingredients that stimulate the growth and activity of bacteria in the gut), a practice known as synbiotic therapy.…”

Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation: a prospective randomized study

“…[7][8][9] Synbiotic therapy is the medical term for comprehensive prebiotic therapy combined with probiotic therapy. 10 It has been used for amelioration of stool character, suppression of toxic substance and immunomodulation for various infectious diseases and is reported to provide good therapeutic efficacy. [9][10][11] Probiotics are bacteria which can provide beneficial effect through maintaining the balance of resident bacteria in the bowel such as bifidus bacterium and lactobacterium etc.…”

“…10 It has been used for amelioration of stool character, suppression of toxic substance and immunomodulation for various infectious diseases and is reported to provide good therapeutic efficacy. [9][10][11] Probiotics are bacteria which can provide beneficial effect through maintaining the balance of resident bacteria in the bowel such as bifidus bacterium and lactobacterium etc. 12,13 Generally, probiotics increase the intestinal motility, and stabilize the intestinal barrier for bacterial location.…”

Probiotics in Surgery

“…2). The meta-analysis of 9 randomized trials undertaken by Pitsouni et al (38) comprising 733 patients subject to abdominal cavity surgery, demonstrated a reduction in the number of patients diagnosed with pneumonia and cholangitis, as well as shorter antibiotic therapy and hospitalization in patients receiving probiotics, as compared to the control group. The Authors observed no statistically significant differences in the occurrence of postoperative wound infections, urinary tract infections, intra-abdominal abscesses and mortality, considering both groups.…”