Probiotic effects in prevention from ventilator-associated pneumonia

How to Cite:Nader zarinfarMojtaba SharafkhahMohammad AmiriMohammad RafeieProbiotic effects in prevention from ventilator-associated pneumonia.koomesh.17(4):e151171.

Abstract

Introduction: Regarding the role of probiotics in the balance of aerodigestive microorganism in the digestive system and the central role of bacteria colonization in the pathogenesis of ventilator associated pneumonia (VAP), the propose of this study was to investigate the effect of probiotics in prevention from ventilation associated pneumonia in ICU patients, who were undergoing mechanical ventilation with high risk for VAP. Materials and Methods: Patients (n=60) hospitalized at ICU of Valiasr Hospital, Arak, Iran participated in a randomized, double-blind, placebo-controlled clinical trial. Patients were randomly divided into two groups (intervention and placebo). Intervention group received Lactobacillus rhamnosus Gagavage three times a day in addition to a routine care. Control group received placebo in addition to a routine care. Demographic and clinical data were recorded and clinical response to primary outcome (prevalence of VAP) and secondary (other clinical factors) was interpreted. Data were analyzed in SPSS 18, using student t-test and chi-square. Results: Twenty two patients (36.6%) were diagnosed with VAP, of which, 7 (23.3%), and 15 (50%) patients were in the probiotic and control groups, respectively. (p=0.03). The average of days spent in ICU (intervention: 14.2±4.7 vs control: 17.6±6.5, p=0.028), hospitalization (intervention: 24.1±5.6 vs control: 27.4±6.6, p=0.041), and number of patients with diarrhea caused by clostridium difficile (intervention: 1(23.3%) vs control: 6 (20%), p=0.04), were significantly lower in the probiotic group than the placebo group. The mean of intubation time till receiving VAP (intervention: 10.5±1.02 vs Control: 6.1±2.6, p=0.008) and full recovery (intervention: 25 (83.3%) vs control: 14(46.6), p=0.028) were significantly higher in the intervention than the control group. Conclusion: These findings successfully presented that probiotics could effectively protect from VAP in a selected, high-risk ICU patients. As a result, the use of this therapy, in patients undergoing long-term intubation is recommended.

Keywords

Probiotics

Ventilator-Associated Pneumonia

Lactobacillus

Clostridium Difficile

پروبیوتیک

پنومنی ناشی از ونتیلاتور

لاکتوباسیلوس

کلستریدیم دیفیسیل

References

1.
Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, Kollef MH. VAP outcomes scientific advisory group. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002; 122: 2115-2121.
2.
Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998; 129: 433-440.
3.
American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388-416.
4.
Ibrahim EH, Tracy L, Hill C, Fraser VJ, Kollef MH. The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes. Chest 2001; 120: 555-561.
5.
Kollef MH. What is ventilator-associated pneumonia and why is it important? Respir Care 2005; 506: 714-721.
6.
Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of healthcare-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005; 128: 3854-3862.
7.
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System. Crit Care Med 1999; 27: 887-892.
8.
Kollef MH. Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Crit Care Med 2004; 32: 1396-1405.
9.
Craven DE. Preventing ventilator-associated pneumonia in adults: sowing seeds of change. Chest 2006; 130: 251-260.
10.
Cook D. Ventilator associated pneumonia: perspectives on the burden of illness. Intensive Care Med 2000; 26: S31-S37.
11.
Dodek P, Keenan S, Cook D, Heyland D, Jacka M, Hand L, et al. Canadian critical care trials Group. Canadian critical care society. evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 2004; 141: 305-313.
12.
Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53: 1-36.
13.
Babcock HM, Zack JE, Garrison T, Trovillion E, Jones M, Fraser VJ, Kollef MH. An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest 2004; 125: 2224-2231.
14.
Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, et al. NASCENT Investigation Group. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 2008; 300: 805-813.
15.
Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am J Respir Crit Care Med 2010; 182: 1058-1064.
16.
Guidelines for the evaluation of probiotics in food: report of a joint FAO/WHO working group on drafting guidelines for the evaluation of probiotics in food (accessed October 3, 2009) Available from: http://www.who.int/foodsafety/fs_management/en/probiotic_guidelines.pdf.
17.
Ghosh S, van Heel D, Playford RJ. Probiotics in inflammatory bowel disease: it is all gut flora modulation? Gut 2004; 53: 620-622.##.
18.
McNaught CE, Woodcock NP, MacFie J, Mitchell CJ. A prospective randomized study of the probiotic Lactobacillus plantarum 299V on indices of guy barrier function in elective surgical patients. Gut 2002; 51: 827-831.
19.
van der Kleij D, Latz E, Brouwers JF, Kruize YC, Schmitz M, Kurt-Jones EA, et al. A novel host-parasite lipid cross-talk: schistosomal lysto-phosphatidylserine activates toll-like receptor 2 and affects immune polarization. J Biol Chem 2002; 277: 48122-48129.
20.
Chapat L, Chemin K, Dubois B, Bourdet-Sicard R, Kaiserlian D. Lactobacillus casei reduces CD8+ T cell-mediated skin inflammation. Eur J Immunol 2004; 34: 2520-2528.
21.
Isolauri E, Sutas Y, Kanaanpaa P, Arvilommi J, Salminen S. Probiotics: effects on immunity. Am J Clin Nutr 2001; 73: 444S-450S.
22.
Walker WA. Mechanisms of action of probiotics. Clin Infect Dis 2008; 46: S87-S91.
23.
Pitsouni E, Alexious V, Saridakis V, Peppas G, Falagas M. Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials. Eur J Pharmacol 2009; 65: 561-570.
24.
Knight DJ, Gardiner D, Banks A, Snape SE, Weston VC, Bengmark S, Girling KJ. Effect of synbiotic therapy on the incidence of ventilator associated pneumonia in critically ill patients: a randomised, double-blind, placebo-controlled trial. Intensive Care Med 2009; 35: 854-861.
25.
van Santvoort HC, Besselink MG, Timmerman HM, van Minnen LP, Akkermans LM, Gooszen HG. Probiotics in surgery. Surgery 2008; 143: 1-7.
26.
Rayes N, Seehofer D, Theruvath T, Schiller RA, Langrehr JM, Jonas S, et al. Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation: a randomized, double-blind trial. Am J Transplant 2005; 5: 125-130.
27.
Falcao de Arruda IS, de Aguilar-Nascimenta JE. Benefits of early enteral nutrition with glutamine and probiotics in brain injury patients. Clin Sci 2004; 106: 287-292.
28.
Gluck U, Gebbers JO. Ingested probiotics reduce nasal colonization with pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and -hemolytic streptococci). Am J Clin Nutr 2003; 77: 517-520.
29.
Hatakka K, Savilahti E, Ponka A, Meurman JH, Poussa T, Nase L, et al. Effect of long-term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ 2001; 322: 1327-1329.
30.
Brandtzaeg P. Humoral immune response patterns of human mucosae: induction and relation to bacterial respiratory tract infections. J Infect Dis 1992; 165: S167-S176.
31.
Knight DJ, Gardiner D, Banks A, Snape SE, Weston VC, Bengmark S, Girling KJ. Effect of synbiotic therapy on the incidence of ventilator associated pneumonia in critically ill patients: a randomised, double-blind, placebo-controlled trial. Intensive Care Med. 2009; 35: 854-861.
32.
Knight DJ, Gardiner D, Banks A, Snape SE, Weston VC, Bengmark S, Girling KJ. Effect of synbiotic therapy on the incidence of ventilator associated pneumonia in critically ill patients: a randomised, double-blind, placebo-controlled trial. Intensive Care Med 2009; 35: 854-861.
33.
Forestier C, Guelon D, Cluytens V, Gillart T, Sirot J, De Champs C. Oral probiotic and prevention of Pseudomonas aeruginosa infections: a randomized, double-blind, placebo controlled pilot study in intensive care unit patients. Crit Care 2008; 12: R69.
34.
Klarin B, Molin G, Jeppsson B, Larsson A. Use of the probiotic Lactobacillus plantarum 299 to reduce pathogenic bacteria in the oropharynx of intubated patients: a randomised controlled open pilot study. Crit Care 2008; 12: R136.
35.
Spindler-Vesel A, Benkgmark S, Vovk I, Cerovic O, Kompan L. Synbiotics, prebiotics, glutamine, or peptide in early enteral nutrition: a randomized study in trauma patients. J Parenter Enteral Nutr 2007; 31: 119-126.
36.
Kotzampassi K, Giamarellos-Bourboulis EJ, Voudouris A, Kazamanias P, Eleftheriadis E. Benefits of a synbiotic formula (Synbiotic 2000Forte) in critically ill trauma patients: early results of a randomized controlled trial. World J Surg 2006; 30: 1848-1855.
37.
Siempos II, Ntaidou TK, Falagas ME. Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Crit Care Med 2010; 38: 954-962.
38.
Wang J, Liu KX, Ariani F, Tao LL, Zhang J, Qu JM. Probiotics for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of high-qualityrandomized controlled trials. PLoS One 2013; 8: e83934.
39.
Barraud D, Blard C, Hein F, Maron O, Cravoisy A, et al. Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial. Intensive Care Med 2010; 36: 1540-1547.
40.
Giamarellos-Bourboulis EJ, Bengmark S, Kanellakopoulou K, Kotzampassi K. Pro- and synbiotics to control inflammation and infection in patients with multiple injuries. J Trauma 2009; 67: 815-821.
41.
The Editors of the Lancet. Expression of concern: probiotic prophylaxis in predicted severe acute pancreatitis: a randomized, double-blind, placebo-controlled trial. Lancet 2010; 375: 875-876.##.

comments