Probiotics for Preventing Ventilator-Associated Pneumonia: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials

Abstract

BackgroundVentilator-associated pneumonia (VAP) is considered to be a worldwide issue along with the development of supportive ventilation. The preventing strategy is of great importance for its poor prognostic and difficulties in treatment. Probiotics have been advocated as one of the possible preventive measures. We conducted a systematic review and meta-analysis to explore the potential benefits of probiotics.MethodsThe databases, Web of science, PubMed, Ovid and Cochrane lib were searched for randomized controlled trials (RCTs) publications that compared the effectiveness of probiotics with placebo in the prevention of VAP. The incidence of VAP was considered as the primary endpoint, mortality, length of stay in intensive care units (ICUs), etiology of the infections were considered as secondary endpoints.ResultsA total of 844 patients from 5 trials were subjected to meta-analysis. Probiotics did not significantly decrease the incidence of VAP (RR 0.94, 95%CI 0.85-1.04, p=0.22), however, the administration of probiotics reduced the risk of VAP caused by Pseudomonas aeruginosa (P. aeruginosa) (RR 0.30, 95%CI 0.11-0.91, P=0.03). It failed to affect any other endpoints.ConclusionProbiotic prophylaxis of ventilator-associated pneumonia remained inconclusive and it failed to improve the prognosis of general mechanically ventilated patients. It was noteworthy that infections caused by P. aeruginosa was reduced by administration of probiotics. In further, it is recommended that advanced studies should exploit transformation in pathogenic microorganisms owing to administration of probiotics as well as the specific population.

Lactobacillus rhamnosus GG treatment improves intestinal permeability and modulates inflammatory response and homeostasis of spleen and colon in experimental model of Pseudomonas aeruginosa pneumonia

“…The effect of LGG on key gut barrier components, including reduced gut apoptosis, enhanced mucin barrier formation and Muc2 expression, and potential effects on tight junction proteins are all targets for future mechanistic explorations of the pathways responsible for the observed survival benefit of probiotics in pneumonia (21). Further, this data provides potential mechanistic explanations for existing clinical trial data showing probiotic therapy can reduce ventilator associated pneumonia (10, 12, 34) and perhaps specifically P. aeruginosa pneumonia (11) in critically ill patients.…”

“…Interestingly, recent meta-analysis data indicates that the clinical benefit of probiotics on pneumonia may be most significant in prevention of pneumonia from P. aeruginosa (11). In support of this, our laboratory has also recently shown that Lactobacillus rhamnosus GG (LGG) (a commonly used clinical probiotic) can reduce mortality and bacteremia from experimental P. aeruginosa pneumonia (21).…”

Gut microbiome, surgical complications and probiotics

“…Thus, the administration of probiotics seems to significantly reduce the risk of VAP caused by P . aeruginosa [74]. …”

Susceptibility to antibiotics in isolates of Lactobacillus plantarum RAPD‐type Lp299v, harvested from antibiotic treated, critically ill patients after administration of probiotics

“…controls (Gu, Wei, & Yin, 2012;Wang et al, 2013). However, little is known about a number of critical issues in this context, such as the possible impact of probiotics on the normal microbiological flora (Imperial & Ibana, 2016), and the effects of administered drugs on the antibiotic susceptibility of probiotics.…”