Efficacy of Probiotics and Prebiotics in Prevention of Infectious Complications Following Hepatic Resections: Systematic Review and Meta-Analysis

Abstract

Background & Aims: Infections occurring after hepatic resection cause significant morbidity, mortality, and prolonged hospitalization. Probiotics and prebiotics are considered to offer protection against post-operative infections. We aimed to determine the effect of probiotics and prebiotics on the post-operative infection rate after hepatic resection by conducting a systematic review and a meta-analysis. Method: We searched various databases, namely, the PubMed, Medline, Embase, and Cochrane Controlled Trials Registry (CENTRAL), for randomized controlled trials evaluating the effect of probiotics and/or prebiotics on the infection rate following hepatic resection. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Review was reported following the PRISMA guidelines. Results: A total of 4 studies comprising 205 patients were included for our meta-analysis. The infection rates in the probiotic group and placebo group were 11.7% and 30.3%, respectively (p<0.001). The pooled risk ratio (RR) was 0.41 (95% confidence interval [CI]: 0.128–0.730). Subgroup analysis indicated that the wound infection rate in the probiotic group (5.3%) was significantly lower than that in the placebo group (RR: 0.387, 95% CI: 0.155–0.970, p=0.043). Furthermore, probiotics/prebiotics decreased the duration of hospital stay (-0.57 days; 95% CI: -0.861 to -0.274; p<0.001) and antibiotic use (mean difference: -3.89 days, 95% CI: -4.17 to -3.60; p<0.001). There was no significant statistical heterogeneity. Conclusion: Our findings show that administration of probiotics and/or prebiotics prior to operation day decreases the infection rate post-liver resection and could shorten the duration of hospitalization and antibiotics use.

Efficacy of Using Probiotics with Antagonistic Activity against Pathogens of Wound Infections: An Integrative Review of Literature

“…Although this review is directed at the antimicrobial role of probiotics in combating wound infections and has shown promising results as possible alternatives or adjuvant therapies, the problem is still more complex. In order to achieve optimal wound healing, it is necessary to address in parallel additional factors regarding the patient's general health or the wound's physical environment and the body's immune response [23,151]. Despite the fact that it is known that wound healing is impaired by wound infection, the exact role of probiotics in delayed wound healing remains controversial due to discrepancy in clinical results [14,64,152].…”

Effects of both Pro- and Synbiotics in Liver Surgery and Transplantation with Special Focus on the Gut–Liver Axis—A Systematic Review and Meta-Analysis

“…Surgical stress-related dysbiosis leads to bacterial translocation resulting in a limited detoxification function of the liver being the central hub of the gut–liver axis, increased susceptibility to infections, and worse outcome. After liver surgery, about 30% of the patients develop a bacterial infection, and if bacteremia occurs, the risk of liver failure increases to over 50% and mortality to over 40% [ 1 , 14 , 15 ].…”

“…LR, which is especially performed for tumors, is associated with both mortality and morbidity of 3.5% and 10–15%, respectively [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. About 30% of patients develop a bacterial infection and about 10% intra-abdominal sepsis, mostly caused by enterogenic bacteria after LR.…”

“…The incidence of bacterial infections increases to up to 45% after extensive LR. With bacteremia, the risk of liver failure increases to >50% with a mortality of >40% [ 1 , 14 , 15 ]. Postoperative infections are the main reason for both morbidity and mortality, which are also associated with high treatment costs [ 16 ].…”

Review article: FODMAPS, prebiotics and gut health‐the FODMAP hypothesis revisited

“…The general acceptance of the health benefits of prebiotics is based upon metabolic and immunological end-points, but these have seldom been backed up by quality data on healthrelated outcomes in clinical trials in most areas of study, as shown in systematic reviews in several areas of health promotion [11,[13][14][15][16][17][18][19][20][21]. The difficulty in showing benefits might, as discussed above, relate to the lack of consideration to background diet in the design of trials, or it might relate to the fact that the concept is overblown and benefits may be very modest indeed.…”