Effects of probiotics on ventilator-associated pneumonia

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The increasingly frequent understandings regarding the microbiome arouse particular interest in dysbiosis, especially in the management of critical patients. Recent studies demonstrate the role of probiotics in reducing the chance of infections. In critically ill patients, meta-analyses showed that the use of probiotics resulted in a 25 to 30% reduction in ventilator-associated pneumonia (VAP).

Also read: Could probiotics lead to improved immunity in the Covid-19 pandemic?

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Methods

Randomized, placebo-controlled study, with the participation of 44 ICUs, among them 41 ICU in Canada, 2 in the USA and 1 in Saudi Arabia. A total of 2,653 patients were included, all over 18 years of age, with expected ventilation of at least 72 hours. Patients received 1×1010 colony-forming units of Lactobacillus rhamnosus GG enterally or a placebo solution. The product was administered for 60 days or until discharge from the ICU. The primary outcome was pneumonia associated with mechanical ventilation (PAV) identified by new radiographic infiltrate associated with two more: fever (temperature> 38 °C) or hypothermia (6/L or greater than 10×106/L and purulent expectoration. Secondary outcomes included other forms of pneumonia and infectionsÇ. difficile.

Results

Among 1,318 patients who received Lactobacillus rhamnosus GG, 289 (21.9%) developed VAP compared with 284 of 1,332 patients (21.3%) who received placebo (HR 1.03, 95% CI, 0.87-1.22 , p=0.73). There was no significant difference regarding secondary outcomes. The use of antimicrobials was not significant between the placebo and probiotic groups. The average number of days of mechanical ventilation was 7, stay in the ICU for 12 days and hospital stay 22 days. There was no difference between the two groups and there was also no difference in mortality. Regarding adverse events, 12 patients had the presence of Lactobacillus rhamnosus GG in previously sterile sites (1 in blood, 1 liver abscess, 1 intra-abdominal abscess, 1 peritoneal fluid, 1 pleural fluid and 2 in urine).

Know more: Probiotics: what the doctor needs to know?

Discussion

In this study involving critically ill patients, the probiotic L rhamnosus GG did not significantly reduce the risk of PAV,

Ç. difficile or other infections. Furthermore, no effects on diarrhea, use of antimicrobials, length of stay or mortality were identified. These results differ from meta-analyses of previous small, predominantly single-center studies, suggesting decreased rates of VAP associated with probiotics during critical illness, including this strain. These results indicate that while critically ill patients exhibit loss of commensal microbiota, overgrowth of potential pathogens, and therefore highly disturbed microbial communities, probiotics may not improve clinically important outcomes associated with dysbiosis in this setting.

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