Prophylactic Probiotics in Burn Patients: Risk versus Reward

Abstract

Probiotics are often used in critically ill patients to prevent antibiotic-associated complications, including Clostridium difficile colitis. However, clinical evidence of their efficacy is lacking. The objective of this study is to assess the impact of prophylactic probiotic administration on bowel function, gut microbial diversity, and nutritional markers in adult burn patients. A retrospective cohort study was done on 108 burn patients aged 18 to 89. Patients were given >1 million colony-forming units per day of Lactobacillus acidophilus and Lactobacillus rhamnosus. Testing for C. difficile was used as a surrogate marker for the presence of diarrhea. Serum C-reactive protein and prealbumin values were measured. Additionally, the gut microbial diversity of eight patients was tracked via 16S quantitative PCR before and throughout the course of a standard probiotic regimen. Patients receiving oral probiotics had more reported diarrhea in the first and second weeks of treatment. In the second week, C-reactive protein levels were increased, while serum prealbumin levels were lower in patients receiving probiotics, suggesting potential malabsorption. Additionally, there was no difference in C. difficile infection, sepsis rates, emesis, or gastric residuals, indicating an absence of therapeutic benefit for probiotic administration in burn patients. Furthermore, it was determined that no discernible benefit to gut microbial diversity was conferred by probiotic therapy. Prophylactic probiotics in burn patients are not associated with improvements in patient outcomes and may in fact be associated with an increased incidence of diarrhea and malabsorption. Additional research is needed before routine use in burn patients.

Microbiome Modulation as a Therapeutic Approach in Chronic Skin Diseases

“…Fleming et al performed a retrospective study in connection with preventing potential antibiotic-associated C. difficile colitis by giving probiotics to burned patients in a critical condition. Otherwise, they found no significant difference in C. difficile infection between the control group and the intervention group [117]. Olguin et al proposed that the regular intake of prebiotics might help to increase the gastrointestinal permeability in burn patients.…”

Efficacy of probiotics or synbiotics in critically ill patients: A systematic review and meta- analysis

“…The risk of CDI was not signi cantly different between the treatment and control groups in four trials (RR = 1.11; 95% CI: 0.73-1.70, p = 0.384, I 2 = 1.7%), but the incidence of sepsis was signi cantly lower in the treatment group than in the control group in eight trials (RR = 0.97; 95% CI: 0.66-1.42, p = 0.032, I 2 = 54.4%). Subgroup analysis of sepsis incidence by trial design showed that probiotics or synbiotics had no effect on the incidence of sepsis in two cohort studies (RR = 1.34; 95% CI: 0.82-2.19, p = 0.396, I 2 = 0.00%) [20,22], but lowered the incidence of sepsis in six RCTs (RR = 0.85; 95% CI: 0.51-1.40, p = 0.023, I 2 = 61.8%). There was no difference in the incidence of hospital-acquired pneumonia between patients receiving probiotics or synbiotics and those receiving placebo (p > 0.05 for all).…”

“…All clinical trials were double-blinded except for the studies conducted by reference [3,27,28,33]. Four studies were retrospective cohort studies [15,20,22,26], and 8 were multi-center studies [5,18,19,24,32,33,39,42]. These trials were published between 2004 and 2022, with sample sizes in individual trials ranging from 19 to 2650.…”

The role and therapeutic potential of gut microbiome in severe burn

“…However, no significant difference was found in the infection rate and sepsis rate of Clostridium difficile infection (CDI), indicating that prophylactic probiotic supplementation in patients with burns is not related to the improvement of prognosis. It may be associated with an increased incidence of diarrhoea and malabsorption ( Fleming et al., 2019 ). Therefore, the effect of probiotic supplementation in patients with severe burn needs to be further studied to understand the mechanism of microbiota as a target for treatment.…”