Influencia de los simbióticos en la disfunción multiorgánica: ensayo aleatorizado

Martín-Consuegra, Ismael López de Toro; Sánchez-Casado, M.; Sánchez-Belmonte, María José Pérez-Pedrero; Torrijos, Pilar López-Reina; Sánchez-Rodríguez, P.; Raigal-Caño, A.; Heredero-Gálvez, Eva; Zubigaray, Susana Brea; Arrese-Cosculluela, M. Ángeles

doi:10.1016/j.medcli.2013.09.046

Cited by 16 publications

(7 citation statements)

References 28 publications

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“…Unclear timeframe. EN (standard) 27 Lopez de Toro 2014 [ 23 ] Medical and surgical ICU patients with multi-organ failure n = 89 C.Random: yes ITT: yes Blinding: no Score: 11 Viability (intervention): NR EN EN + symbiotic drink with streptococcus Thermophilus, lactobacillus bulgaricus , Lactobacillus casei , lactobacillus acidophilus , bifidobacterium , Escherichia coli , coliformes × 7 days (max 4.8 × 10 9 UFC/ml). EN and PN 28 Sanaie 2014 [ 24 ] Critically ill pts, SIRS, expected length of stay ≥7 days n = 40 C.Random: yes ITT: yes Blinding: double Score: 9 Viability (intervention): yes NG tube EN (standard) + 2 sachets VSL#3 BID × 7 days.…”

Section: Resultsmentioning

confidence: 99%

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: Resultsmentioning

confidence: 99%

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

et al. 2016

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“…The incidence of BSI was similar (18% and 27%) in the probiotic and control group respectively; the commonly isolated organisms were Pseudomonas aeruginosa and MR-CONS. Based on our observations of previous studies,, a decrease in incidence of bacteremia was observed with administration of probiotics [18,23]. In addition to reduced incidence of VAP and BSI, it was also reported that the probiotic administration was associated with a decreasing trend of other septic complications, urinary tract infections and soft tissues infections [18].…”

Section: Discussionmentioning

confidence: 71%

Study on Effects of Probiotics on Gut Microbiome and Clinical Course in Patients with Critical Care Illnesses

et al. 2023

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Ventilator Associated Pneumonia (VAP) is a nosocomial infection contracted by patients on ventilators, where bacteria colonize the upper digestive tract and contaminated secretions are released into the lower airway. This nosocomial infection increases the morbidity and mortality of the patients as well as the cost of treatment. Of late Probiotic formulations are postulated to prevent the colonization of these pathogenic bacteria. In this prospective observational study, we aimed to investigate the effects of probiotics on gut microbiota and their relation to clinical outcomes in mechanically ventilated patients. For this study, 30 patients were recruited (20 probiotic treated and 10 without probiotic treatment) screened from a cohort of 169 patients. Patients in the probiotic group were given a dose of 6 capsules of commercially available probiotic (VSL#3®:112.5 billion CFU/cap) in three divided doses for 10 days. Sampling was carried out after each dose to monitor the temporal change in the gut microbiota composition. To profile the microbiota, we used a 16S rRNA based targeted metagenomic approach and differences among the groups were computed using multivariate statistical analyses. Differences in gut microbial diversity (Bray Curtis & Jaccard distance, p-value < 0.05) among the probiotic treated group and the control group were observed. Furthermore, treatment with probiotics resulted in the enrichment of Lactobacillus and Streptococcus in the gut microbiota of the probiotic-treated groups. Our results demonstrated that probiotics may lead to favourable alteration in gut microbiome characteristics. Future studies should focus on appropriate dosages and frequency of probiotics, which can lead to improved clinical outcomes.

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“…Of 65 trials, close to half were at probably high RoB (21, 26, 30, 32, 33, 35, 39, 43–67) ( n = 2,674). Of the remaining, two were judged to be at high RoB (62, 68) ( n = 129), 26 trials at probably low RoB (22, 24, 27–29, 31, 34, 36, 40–42, 69–83) ( n = 2,300), and seven trials were judged to be at low RoB (15, 20, 23, 25, 38, 84, 85) ( n = 3,380) (Supplementary Appendix 9, Supplement Table 2, http://links.lww.com/CCM/H132, for all RoB judgments).…”

Section: Resultsmentioning

confidence: 99%

Probiotics in Critical Illness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Sharif

Greer

Skorupski

et al. 2022

Critical Care Medicine

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OBJECTIVES: To determine the safety and efficacy of probiotics or synbiotics on morbidity and mortality in critically ill adults and children. DATA SOURCES: We searched MEDLINE, EMBASE, CENTRAL, and unpublished sources from inception to May 4, 2021. STUDY SELECTION: We performed a systematic search for randomized controlled trials (RCTs) that compared enteral probiotics or synbiotics to placebo or no treatment in critically ill patients. We screened studies independently and in duplicate. DATA EXTRACTION: Independent reviewers extracted data in duplicate. A random-effects model was used to pool data. We assessed the overall certainty of evidence for each outcome using the Grading Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Sixty-five RCTs enrolled 8,483 patients. Probiotics may reduce ventilator-associated pneumonia (VAP) (relative risk [RR], 0.72; 95% CI, 0.59 to 0.89 and risk difference [RD], 6.9% reduction; 95% CI, 2.7–10.2% fewer; low certainty), healthcare-associated pneumonia (HAP) (RR, 0.70; 95% CI, 0.55–0.89; RD, 5.5% reduction; 95% CI, 8.2–2.0% fewer; low certainty), ICU length of stay (LOS) (mean difference [MD], 1.38 days fewer; 95% CI, 0.57–2.19 d fewer; low certainty), hospital LOS (MD, 2.21 d fewer; 95% CI, 1.18–3.24 d fewer; low certainty), and duration of invasive mechanical ventilation (MD, 2.53 d fewer; 95% CI, 1.31–3.74 d fewer; low certainty). Probiotics probably have no effect on mortality (RR, 0.95; 95% CI, 0.87–1.04 and RD, 1.1% reduction; 95% CI, 2.8% reduction to 0.8% increase; moderate certainty). Post hoc sensitivity analyses without high risk of bias studies negated the effect of probiotics on VAP, HAP, and hospital LOS. CONCLUSIONS: Low certainty RCT evidence suggests that probiotics or synbiotics during critical illness may reduce VAP, HAP, ICU and hospital LOS but probably have no effect on mortality.

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Influencia de los simbióticos en la disfunción multiorgánica: ensayo aleatorizado

Cited by 16 publications

References 28 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

Study on Effects of Probiotics on Gut Microbiome and Clinical Course in Patients with Critical Care Illnesses

Probiotics in Critical Illness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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