Probiotics' effects on the incidence of nosocomial pneumonia in critically ill patients: a systematic review and meta-analysis

Liu Kai-Xiong, Zhu Ying-Gang, Jing Zhang, Tao Li-Li, Lee Jae-Woo, Wang Xiao-Dan, Qu, Qu Jie-Ming

Description

To evaluate the efficacy of probiotics in preventing nosocomial pneumonia in critically ill patients. Methods We searched PubMed, EMBASE, and the Web of Science for relevant studies. Two reviewers extracted data and reviewed the quality of the studies independently. The primary outcome was the incidence of nosocomial pneumonia. Study-level data were pooled using a random-effects model when I 2 was > 50% or a fixed-effects model when I 2 was < 50%. Results Twelve randomized controlled studies with a total of 1,546 patients were considered. Pooled analysis showed a statistically significant reduction in nosocomial pneumonia rates due to probiotics (odd ratio [OR]= 0.75, 95% CI 0.57 to 0.97, P = 0.03, I 2 = 46%). However, no statistically significant difference was found between groups regarding in-hospital mortality (OR = 0.93, 95% CI 0.50 to 1.74, P = 0.82, I 2 = 51%), intensive care unit mortality (OR = 0.84, 95% CI 0.55 to 1.29, P = 0.43, I 2 = 0%), duration of stay in the hospital (mean difference [MD] in days = -0.13, 95% CI -0.93 to 0.67, P = 0.75, I 2 = 46%), or duration of stay in the intensive care units (MD = -0.72, 95% CI -1.73 to 0.29, P = 0.16, I 2 = 68%). Conclusions The use of probiotics was associated with a statistically significant reduction in the incidence of nosocomial pneumonia in critically ill patients. However, large, well-designed, randomized, multi-center trials are needed to confirm any effects of probiotics clinical endpoints such as mortality and length of ICU and hospital stay.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 9
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Liuet al.Critical Care2012,16:R109 http://ccforum.com/content/16/3/R109

R E S E A R C HOpen Access Probiotics’effects on the incidence of nosocomial pneumonia in critically ill patients: a systematic review and metaanalysis 1†1†3 21*2 1 Kaixiong Liu, Yinggang Zhu, Jing Zhang , Lili Tao , JaeWoo Lee , Xiaodan Wangand Jieming Qu

Abstract Introduction:To evaluate the efficacy of probiotics in preventing nosocomial pneumonia in critically ill patients. Methods:We searched PubMed, EMBASE, and the Web of Science for relevant studies. Two reviewers extracted data and reviewed the quality of the studies independently. The primary outcome was the incidence of 2 nosocomial pneumonia. Studylevel data were pooled using a randomeffects model whenIwas > 50% or a 2 fixedeffects model whenIwas < 50%. Results:Twelve randomized controlled studies with a total of 1,546 patients were considered. Pooled analysis showed a statistically significant reduction in nosocomial pneumonia rates due to probiotics (odd ratio [OR]= 0.75, 2 95% CI 0.57 to 0.97,P= 0.03,I= 46%). However, no statistically significant difference was found between groups 2 regarding inhospital mortality (OR = 0.93, 95% CI 0.50 to 1.74,P= 0.82,I= 51%), intensive care unit mortality (OR = 2 0.84, 95% CI 0.55 to 1.29,P= 0.43,I = 0%), duration of stay in the hospital (mean difference [MD] in days = 0.13, 2 95% CI 0.93 to 0.67,P= 0.75,I= 46%), or duration of stay in the intensive care units (MD = 0.72, 95% CI 1.73 to 2 0.29,P= 0.16,I= 68%). Conclusions:The use of probiotics was associated with a statistically significant reduction in the incidence of nosocomial pneumonia in critically ill patients. However, large, welldesigned, randomized, multicenter trials are needed to confirm any effects of probiotics clinical endpoints such as mortality and length of ICU and hospital stay.

Introduction Nosocomial pneumonia (NP) is a common complication in critically ill patients, particularly in patients who are intubated for more than 48 hours, and NP is responsible for significant inhospital morbidity and mortality [13]. When mechanically ventilated patients develop NP, it is known as ventilatorassociated pneumonia (VAP) [1,2]. Multiple hospitalassociated risk factors for NP have been identified. These risk factors are thought to contri bute to increased bacterial colonization of the aerodiges tive tract and facilitate the entry of pathogenic bacteria into the lower respiratory tract [4].

* Correspondence: [e-mail] †Contributed equally 1 Department of Pulmonary Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, 221 Yananxi Road, Shanghai 200040, China Full list of author information is available at the end of the article

Considerable efforts have been made to evaluate methods for reducing NP. For example, selective diges tive tract decontamination in critically ill patients has been shown to reduce the occurrence of NP; however such decontamination has also been associated with increased rates of antimicrobial resistance [5,6]. Several experimental and clinical studies have suggested a pro mising effect of probiotics on preventing NP in critically ill patients [710]. Probiotics are commercially available microorganisms that when ingested as individual strains or in combination may offer potential health benefits to the host [11]. Prebio tics are nondigestible sugars that selectively stimulate the growth of certain bacteria colonies. The combination of pre and probiotics has been designated as synbiotics. It is hypothesized that probiotics could potentially reduce the incidence of NP in critically ill patients through various local and systemic effects that minimize colonization by

© 2012 Liu et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.