Perioperative supplementation with bifidobacteria improves postoperative nutritional recovery, inflammatory response, and fecal microbiota in patients undergoing colorectal surgery: a prospective, randomized clinical trial

Abstract

The use of probiotics has been widely documented to benefit human health, but their clinical value in surgical patients remains unclear. The present study investigated the effect of perioperative oral administration of probiotic bifidobacteria to patients undergoing colorectal surgery. Sixty patients undergoing colorectal resection were randomized to two groups prior to resection. One group (n=31) received a probiotic supplement, Bifidobacterium longum BB536, preoperatively for 7–14 days and postoperatively for 14 days, while the other group (n=29) received no intervention as a control. The occurrences of postoperative infectious complications were recorded. Blood and fecal samples were collected before and after surgery. No significant difference was found in the incidence of postoperative infectious complications and duration of hospital stay between the two groups. In comparison to the control group, the probiotic group tended to have higher postoperative levels of erythrocytes, hemoglobin, lymphocytes, total protein, and albumin and lower levels of high sensitive C-reactive proteins. Postoperatively, the proportions of fecal bacteria changed significantly; Actinobacteria increased in the probiotic group, Bacteroidetes and Proteobacteria increased in the control group, and Firmicutes decreased in both groups. Significant correlations were found between the proportions of fecal bacteria and blood parameters; Actinobacteria correlated negatively with blood inflammatory parameters, while Bacteroidetes and Proteobacteria correlated positively with blood inflammatory parameters. In the subgroup of patients who received preoperative chemoradiotherapy treatment, the duration of hospital stay was significantly shortened upon probiotic intervention. These results suggest that perioperative oral administration of bifidobacteria may contribute to a balanced intestinal microbiota and attenuated postoperative inflammatory responses, which may subsequently promote a healthy recovery after colorectal resection.

The endotracheal tube microbiome associated with Pseudomonas aeruginosa or Staphylococcus epidermidis

“…The ETT microbiome of the latter group of patients tended to harbour the phylum Actinobacteria, which include Bifidobacteria , commonly used as probiotics, and non-diptheriae Corynebacteriaceae . Interestingly, a recent study analysing the benefits of probiotic Bifidobacterium longum administration in patients undergoing surgery, showed that an increase in relative abundance of Actinobacteria in the gut correlated inversely with blood inflammatory parameters32. These data support our findings that surviving patients tend to harbour a ‘healthy’ microbiome.…”

Efficacy of prophylactic probiotics in combination with antibiotics versus antibiotics alone for colorectal surgery: A meta‐analysis of randomized controlled trials

“…The prophylactic probiotics were mostly Lactobacillus (10/14) and Bifidobacterium (12/15) based, while the preoperative antibiotics prophylaxis regimens varied across studies. Despite all studies performed mechanical bowel preparation, only one study applied oral antibiotics, one study applied both oral and intravenous infusion of antibiotics, and most of the studies used intravenous infusion of cephalosporins plus metronidazole, one used intravenous infusion of gentamicin plus metronidazole, and three studies used intravenous infusion of cephalosporins alone . Most trials conducted power calculation (13/14), many did not apply intention‐to‐treat analysis (11/14) …”

“…Thirteen trials involving 1374 participants reported the incidence of SSI . Overall, prophylactic probiotics in combination with antibiotics significantly reduced the incidence of SSI (RR: 0.72; 95%CI: 0.56‐0.92; P = 0.009) (12.72% [86/676] vs 18.34% [128/698]; overall 15.51%), with no heterogeneity ( I 2 = 0%).…”

“…These trials were published during the last decade Despite all studies performed mechanical bowel preparation, only one study applied oral antibiotics, 27 one study applied both oral and intravenous infusion of antibiotics, 30 and most of the studies used intravenous infusion of cephalosporins plus metronidazole, 28,29,31,32,36,37,39,40 one used intravenous infusion of gentamicin plus metronidazole, 34 and three studies used intravenous infusion of cephalosporins alone. 33,35,38 Most trials conducted power calculation (13/14), 27-29,31-40 many did not apply intention-to-treat analysis (11/ 14). 27,29,30,[32][33][34][35][36][38][39][40]…”

“…Currently, adjuvant probiotics supplements displayed positive effects in various surgical settings and have been extensively applied, [20][21][22][23][24] yet the efficacy of the prophylactic probiotics in combination with antibiotics has neither been evaluated, nor recommended in the guidelines. [10][11][12]25,26 Considering the evidence regarding prophylactic probiotics in colorectal surgery is quickly evolving and conveyed conflicting results, [27][28][29][30][31][32][33][34][35][36][37][38][39][40] we conducted a meta-analysis to define whether prophylactic probiotics in combination with antibiotics could better prevent SSI and reduce the use of antibiotics. We hypothesized that prophylactic probiotics in combination with antibiotics are associated with reduced risk of SSI in patients undergoing colorectal surgery.…”