Supply of Pre- and Probiotics Reduces Bacterial Infection Rates After Liver Transplantation—A Randomized, Double-Blind Trial

Abstract

Bacterial infections frequently occur early after liver transplantation. We recently reported significant progress with a synbiotic composition, consisting of one lactic acid bacteria (LAB) and one fiber, which reduced the infection rate from 48% (with selective bowel decontamination) to 13%. Now, our aim is to study if a combination of different LAB and fibers would further improve outcome.A prospective randomized double-blind trial was undertaken in 66 liver transplant recipients. All patients received enteral nutrition immediately postoperatively. Comparison was made between one group (A) receiving a composition of four LAB and four fibers and another group (B) receiving the fibers only. The treatment started the day before surgery and continued for 14 days. Thirty-day infection rate, length of hospital stay, duration of antibiotic therapy, noninfectious complications and side effects of enteral nutrition were recorded.The incidence of post-operative bacterial infections was significantly reduced; being 48% with only fibers and 3% with LAB and fibers. In addition, the duration of antibiotic therapy was significantly shorter in the latter group. In both groups, mainly mild or moderate infections occurred. Fibers and LAB were well tolerated.Early enteral nutrition supplemented with a mixture of LAB and fibers reduces bacterial infection rates following liver transplantation. Treatment with only fibers led to a low incidence of severe infections.

In vitro and in vivo defensive effect of probiotic LAB against Pseudomonas aeruginosa using Caenorhabditis elegans model

“…However, few of these studies included testing for digestive enzymes [65]. Other relevant studies on probiotics examined combined effects, for example, of pepsin and pH or pancreatic enzyme and bile salts [66]. Notably, well-studied probiotics were subjected to individual and multiple stress-based assays and were found to be highly resistant to bile salts and digestive enzymes under an acidic pH of 2.0 [67].…”

Synbiotic Therapy Reduces the Pathological Gram-Negative Rods Caused by an Increased Acetic Acid Concentration in the Gut

“…However, most of these previous reports did not examine the changes in the gut flora that resulted from the synbiotic therapy [1][2][3][6][7][8][9][10][11][12].…”

“…Previous reports have described the effects of probiotics/synbiotics for general infectious complications in various patients, such as liver transplantation [1,2], major abdominal surgery [3][4][5], severe acute pancreatitis [6][7][8], trauma [9,10], and critically ill patients [11][12][13]. However, these reports generally did not examine changes in the gut flora following probiotic/synbiotic therapy [1][2][3][6][7][8][9][10][11][12].…”

HCC Is promoted by bacterial translocation and TLR-4 signaling: A new paradigm for chemoprevention and management

“…8 The use of probiotics and antibiotics has been shown to reduce bacterial translocation in a mouse model of sepsis and decrease liver injury in patients with cirrhosis. [9][10][11] Dapito et al demonstrated the efficacy of rifaximin, a nonabsorbable antibiotic already used in subjects with advanced liver disease and hepatic encephalopathy, for reducing promotion of HCC in their mouse model. It would have been interesting to explore the effect of norfloxacin in HCC promotion, considering that it is the standard antibiotic used for prevention of spontaneous bacterial peritonitis and infections in high-risk patients who have cirrhosis.…”