Effectiveness of probiotics for prevention of ventilator-associated pneumonia: a systematic review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WEI Lu ¹ ,  ZHANG Xianhong ² , WANG Qi ¹ , YU Jing ¹

1. Department of Pediatrics, Chongqing Medical University, Chongqing 400016, P. R. China;
2. Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Chongqing 400014, P. R. China;

Corresponding author：

ZHANG Xianhong, Email: 2251867562@qq.com

Keywords：

Probiotics; Mechanical ventilation; Ventilator-associated pneumonia

DOI：

10.7507/1671-6205.201709015

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ObjectiveTo systematically evaluate the efficacy and safety of probiotics for prevention of ventilator-associated pneumonia (VAP).MethodsThe Web of Science, Pubmed, OVID, Cochrane Library, CNKI, EMbase, Sciencedirect, Chinese biomedical database, and Wanfang database before August 2017 were searched, and the relevant data resources were also searched by hand to collect randomized controlled trials (RCTs) of probiotics for prevention of VAP. The quality of the included studies was evaluated using a modified version of the Jadad scale. Meta-analysis was performed with RevMan 5.3 software.ResultsA total of 16 RCTs were included. The use of probiotics can reduce the incidence of VAP [RR=0.71, 95%CI (0.62, 0.80), P<0.000 01], ICU days [MD=–3.28, 95%CI (–6.15, –0.41), P=0.03] and total duration of antibiotics [MD=–2.47, 95%CI (–4.89, –0.04), P=0.05], but can not reduce the mortality of ICU [RR=0.99, 95%CI (0.74, 1.32), P=0.94], hospital mortality [RR=0.77, 95%CI (0.58, 1.01), P=0.06], 28-day mortality [RR=1.01, 95%CI (0.69, 1.47), P=0.97], 90-day mortality [RR=1.00, 95%CI (0.72, 1.37), P=0.99], hospital stays [MD=–0.68, 95%CI (–3.88, 2.52), P=0.68], duration of mechanical ventilation [MD=–2.17, 95%CI (–4.78, 0.44), P=0.10], or the incidence of diarrhea [RR=0.96, 95%CI (0.80, 1.14), P=0.62]. No serious adverse events were reported in all included RCTs.ConclusionsThe use of probiotics can reduce the incidence of VAP, but it has no effect on the mortality, hospital stay, duration of mechanical ventilation or the incidence of diarrhea. However, considering the heterogeneity of research designs, we need more rigorous, large sample randomized controlled studies to increase the strength of evidence.

Citation： WEI Lu, ZHANG Xianhong, WANG Qi, YU Jing. Effectiveness of probiotics for prevention of ventilator-associated pneumonia: a systematic review. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(2): 144-154. doi: 10.7507/1671-6205.201709015 Copy

1.	Ding C, Zhang Y, Yang Z, et al. Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis. BMC infect dis, 2017, 17(1):468.
2.	Blot S, Koulenti D, Dimopoulos G, et al. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit Care Med, 2014, 42(3):601-609.
3.	Cernada M, Brugada M, Golombek S, et al. Ventilator-associated pneumonia in neonatal patients: an update. Neonatology, 2014, 105(2):98-107.
4.	Morrow LE, Gogineni V, Malesker MA. Probiotic, prebiotic, and synbiotic use in critically ill patients. Curr Opin Crit Care, 2012, 18(2):186-191.
5.	Vitko HA, Sekula LK, Schreiber MA. Probiotics for Trauma Patients: Should We Be Taking a Precautionary Approach??. J Trauma Nurs, 2017, 24(1): 46-52.
6.	栾嵘. 益生菌制剂预防呼吸机相关性肺炎的系统评价. 中国医院药学杂志, 2014, 3(34):208-215.
7.	Bo L, Li J, Tao T, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev, 2014, (10): CD009066.
8.	Zeng J, Wang CT, Zhang FS, et al. Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial. Intensive Care Med, 2016, 42(6):1018-1028.
9.	Zarinfar NS, M.; Amiri, M.; Rafeie, M. Probiotic effects in prevention from ventilator-associated pneumonia.. Koomesh. 2016, 17(4):803-13.
10.	Yong Rongrungruang DK, Kittisak Pholtawornkulchai. Randomized controlled study of probiotics containing Lactobacillus casei (Shirota strain) for prevention of ventilator-associated pneumonia. J Med Assoc Thai, 2015, 98(3):253-259.
11.	刘文娟. 益生菌应用对机械通气患者发生呼吸机相关性肺炎的影响[D]. 山东: 滨州医院, 2015.
12.	王定淼, 陈琳, 陈勇, 等. 早期应用复合乳酸菌预防呼吸机相关肺炎的临床疗效及对炎症因子的影响研究. 临床肺科杂志, 2015, 20(9): 1645-1648.
13.	Tan M, Zhu JC, Du J, et al. Effects of probiotics on serum levels of Th1/Th2 cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study. Crit care, 2011, 15(6): R290.
14.	Oudhuis GJ, Bergmans DC, Dormans T, et al. Probiotics versus antibiotic decontamination of the digestive tract: infection and mortality. Intensive Care Med, 2011, 37(1):110-117.
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(8):1058-1064.
16.	Barraud D, Blard C, Hein F, et al. Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial. Intensive Care Med, 2010, 36(9):1540-1547.
17.	Knight DJW, Gardiner D, Banks A, et al. 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(5):854-861.
18.	Giamarellos-Bourboulis EJ, Bengmark S, Kanellakopoulou K, et al. Pro- and synbiotics to control inflammation and infection in patients with multiple injuries. J Trauma. 2009, 67(4):815-821.
19.	张全超, 冯少林. 复合乳酸菌预防呼吸机相关性肺炎的临床价值. 现代医院, 2008, 8(5):18-19.
20.	Klarin B, Molin G, Jeppsson B, et al. 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(6): R136.
21.	Forestier C, Guelon D, Cluytens V, et al. 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(3):R69.
22.	Spindler-Vesel A, Bengmark S, Vovk I, Cerovic O, et al. Synbiotics, prebiotics, glutamine, or peptide in early enteral nutrition: a randomized study in trauma patients. J Parenter Enteral Nutr, 2007, 31(2): 119-126.
23.	Kotzampassi K, Giamarellos-Bourboulis EJ, Voudouris A, et al. Benefits of a synbiotic formula (Synbiotic 2000Forte®) in critically Ill trauma patients: early results of a randomized controlled trial. World J Surg, 2006, 30(10): 1848-1855.

1. Ding C, Zhang Y, Yang Z, et al. Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis. BMC infect dis, 2017, 17(1):468.
2. Blot S, Koulenti D, Dimopoulos G, et al. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit Care Med, 2014, 42(3):601-609.
3. Cernada M, Brugada M, Golombek S, et al. Ventilator-associated pneumonia in neonatal patients: an update. Neonatology, 2014, 105(2):98-107.
4. Morrow LE, Gogineni V, Malesker MA. Probiotic, prebiotic, and synbiotic use in critically ill patients. Curr Opin Crit Care, 2012, 18(2):186-191.
5. Vitko HA, Sekula LK, Schreiber MA. Probiotics for Trauma Patients: Should We Be Taking a Precautionary Approach??. J Trauma Nurs, 2017, 24(1): 46-52.
6. 栾嵘. 益生菌制剂预防呼吸机相关性肺炎的系统评价. 中国医院药学杂志, 2014, 3(34):208-215.
7. Bo L, Li J, Tao T, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev, 2014, (10): CD009066.
8. Zeng J, Wang CT, Zhang FS, et al. Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial. Intensive Care Med, 2016, 42(6):1018-1028.
9. Zarinfar NS, M.; Amiri, M.; Rafeie, M. Probiotic effects in prevention from ventilator-associated pneumonia.. Koomesh. 2016, 17(4):803-13.
10. Yong Rongrungruang DK, Kittisak Pholtawornkulchai. Randomized controlled study of probiotics containing Lactobacillus casei (Shirota strain) for prevention of ventilator-associated pneumonia. J Med Assoc Thai, 2015, 98(3):253-259.
11. 刘文娟. 益生菌应用对机械通气患者发生呼吸机相关性肺炎的影响[D]. 山东: 滨州医院, 2015.
12. 王定淼, 陈琳, 陈勇, 等. 早期应用复合乳酸菌预防呼吸机相关肺炎的临床疗效及对炎症因子的影响研究. 临床肺科杂志, 2015, 20(9): 1645-1648.
13. Tan M, Zhu JC, Du J, et al. Effects of probiotics on serum levels of Th1/Th2 cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study. Crit care, 2011, 15(6): R290.
14. Oudhuis GJ, Bergmans DC, Dormans T, et al. Probiotics versus antibiotic decontamination of the digestive tract: infection and mortality. Intensive Care Med, 2011, 37(1):110-117.
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(8):1058-1064.
16. Barraud D, Blard C, Hein F, et al. Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial. Intensive Care Med, 2010, 36(9):1540-1547.
17. Knight DJW, Gardiner D, Banks A, et al. 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(5):854-861.
18. Giamarellos-Bourboulis EJ, Bengmark S, Kanellakopoulou K, et al. Pro- and synbiotics to control inflammation and infection in patients with multiple injuries. J Trauma. 2009, 67(4):815-821.
19. 张全超, 冯少林. 复合乳酸菌预防呼吸机相关性肺炎的临床价值. 现代医院, 2008, 8(5):18-19.
20. Klarin B, Molin G, Jeppsson B, et al. 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(6): R136.
21. Forestier C, Guelon D, Cluytens V, et al. 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(3):R69.
22. Spindler-Vesel A, Bengmark S, Vovk I, Cerovic O, et al. Synbiotics, prebiotics, glutamine, or peptide in early enteral nutrition: a randomized study in trauma patients. J Parenter Enteral Nutr, 2007, 31(2): 119-126.
23. Kotzampassi K, Giamarellos-Bourboulis EJ, Voudouris A, et al. Benefits of a synbiotic formula (Synbiotic 2000Forte®) in critically Ill trauma patients: early results of a randomized controlled trial. World J Surg, 2006, 30(10): 1848-1855.

Chinese Journal of Respiratory and Critical Care Medicine

Effectiveness of probiotics for prevention of ventilator-associated pneumonia: a systematic review

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