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Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis.

Publication ,  Journal Article
Manzanares, W; Lemieux, M; Langlois, PL; Wischmeyer, PE
Published in: Crit Care
August 19, 2016

BACKGROUND: Critical illness is characterized by a loss of commensal flora and an overgrowth of potentially pathogenic bacteria, leading to a high susceptibility to nosocomial infections. Probiotics are living non-pathogenic microorganisms, which may protect the gut barrier, attenuate pathogen overgrowth, decrease bacterial translocation and prevent infection. The purpose of this updated systematic review is to evaluate the overall efficacy of probiotics and synbiotic mixtures on clinical outcomes in critical illness. METHODS: Computerized databases from 1980 to 2016 were searched. Randomized controlled trials (RCT) evaluating clinical outcomes associated with probiotic therapy as a single strategy or in combination with prebiotic fiber (synbiotics). Overall number of new infections was the primary outcome; secondary outcomes included mortality, ICU and hospital length of stay (LOS), and diarrhea. Subgroup analyses were performed to elucidate the role of other key factors such as probiotic type and patient mortality risk on the effect of probiotics on outcomes. RESULTS: Thirty trials that enrolled 2972 patients were identified for analysis. Probiotics were associated with a significant reduction in infections (risk ratio 0.80, 95 % confidence interval (CI) 0.68, 0.95, P = 0.009; heterogeneity I (2) = 36 %, P = 0.09). Further, a significant reduction in the incidence of ventilator-associated pneumonia (VAP) was found (risk ratio 0.74, 95 % CI 0.61, 0. 90, P = 0.002; I (2) = 19 %). No effect on mortality, LOS or diarrhea was observed. Subgroup analysis indicated that the greatest improvement in the outcome of infections was in critically ill patients receiving probiotics alone versus synbiotic mixtures, although limited synbiotic trial data currently exists. CONCLUSION: Probiotics show promise in reducing infections, including VAP in critical illness. Currently, clinical heterogeneity and potential publication bias reduce strong clinical recommendations and indicate further high quality clinical trials are needed to conclusively prove these benefits.

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Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

August 19, 2016

Volume

19

Start / End Page

262

Location

England

Related Subject Headings

  • Treatment Outcome
  • Synbiotics
  • Randomized Controlled Trials as Topic
  • Probiotics
  • Pneumonia, Ventilator-Associated
  • Humans
  • Emergency & Critical Care Medicine
  • Cross Infection
  • Critical Illness
  • Bacterial Infections
 

Citation

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ICMJE
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Manzanares, W., Lemieux, M., Langlois, P. L., & Wischmeyer, P. E. (2016). Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit Care, 19, 262. https://doi.org/10.1186/s13054-016-1434-y
Manzanares, William, Margot Lemieux, Pascal L. Langlois, and Paul E. Wischmeyer. “Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis.Crit Care 19 (August 19, 2016): 262. https://doi.org/10.1186/s13054-016-1434-y.
Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit Care. 2016 Aug 19;19:262.
Manzanares, William, et al. “Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis.Crit Care, vol. 19, Aug. 2016, p. 262. Pubmed, doi:10.1186/s13054-016-1434-y.
Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit Care. 2016 Aug 19;19:262.

Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

August 19, 2016

Volume

19

Start / End Page

262

Location

England

Related Subject Headings

  • Treatment Outcome
  • Synbiotics
  • Randomized Controlled Trials as Topic
  • Probiotics
  • Pneumonia, Ventilator-Associated
  • Humans
  • Emergency & Critical Care Medicine
  • Cross Infection
  • Critical Illness
  • Bacterial Infections