Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial

被引:103
作者
Barraud, Damien [1 ,2 ]
Blard, Claire [3 ]
Hein, Francois [1 ,2 ]
Marcon, Olivier [1 ,2 ]
Cravoisy, Aurelie [1 ,2 ]
Nace, Lionel [1 ,2 ]
Alla, Francois [4 ]
Bollaert, Pierre-Edouard [1 ,2 ]
Gibot, Sebastien [1 ,2 ]
机构
[1] CHU Nancy, Serv Reanimat Med, Hop Cent, F-54035 Nancy, France
[2] CHU Nancy, Ctr Invest Clin, INSERM 9501, F-54035 Nancy, France
[3] CHG Macon, Serv Reanimat Polyvalente, Macon, France
[4] CHU Nancy, Serv Epidemiol & Evaluat Clin, F-54035 Nancy, France
关键词
Mechanical ventilation; ICU-acquired infections; Probiotics; INTENSIVE-CARE-UNIT; TRAUMA PATIENTS; SEPSIS; DEFINITIONS; SYNBIOTICS; INFECTIONS; PREVENTION; PREBIOTICS; PNEUMONIA;
D O I
10.1007/s00134-010-1927-0
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Probiotics have been shown to be able to restore a non-pathogenic digestive flora, to prevent digestive colonization by pathogenic bacteria, and to modulate immunity. The aim of this study was to assess the effects of prophylactic probiotic administration in patients ventilated for up to 2 days. This study was performed as a double-blind, concealed randomized, placebo-controlled trial in a French medical intensive care unit (ICU). Adult patients mechanically ventilated for a period of more than 48 h received enterally administered probiotics (Ergyphilus (A (R)), 2 x 10(10) lactic acid bacteria, mostly Lactobacillus rhamnosus GG, once a day) or placebo until successful weaning. A total of 167 patients were included. The two groups were comparable at baseline. The 28-day mortality rates were not different in the probiotic (25.3%) and placebo groups (23.7%). Mortality rates in ICU and at 90 days were also unaffected by the treatment. The incidence of ICU-acquired infections did not differ significantly except for that of catheter-related bloodstream infections that was lowered by probiotics. On a prespecified subgroup analysis, we found a reduction of the 28-day mortality among severe sepsis patients (total n = 101) treated with probiotics (n = 52) with an odds ratio (OR) for death at 0.38 (95% CI 0.16-0.93, p = 0.035). By contrast, probiotics were associated with a higher mortality rate in non-severe sepsis patients (OR 3.09, 95% CI 0.87-11.01, p = 0.08). Although numerous uncertainties remain (type and the number of strains to use, delay and length of administration), and despite an acceptable safety profile, the daily prophylactic administration of probiotics cannot be encouraged in the critically ill patient.
引用
收藏
页码:1540 / 1547
页数:8
相关论文
共 20 条
[1]  
[Anonymous], [No title captured]
[2]  
[Anonymous], 2002, Guidelines for evaluation of drilled holes and notches in structural glues laminated timber beams
[3]   Intestinal Barrier Dysfunction in a Randomized Trial of a Specific Probiotic Composition in Acute Pancreatitis [J].
Besselink, Marc G. ;
van Santvoort, Hjalmar C. ;
Renooij, Willem ;
de Smet, Martin B. ;
Boermeester, Marja A. ;
Fischer, Kathelijn ;
Timmerman, Harro M. ;
Ali, Usama Ahmed ;
Cirkel, Geert A. ;
Bollen, Thomas L. ;
van Ramshorst, Bert ;
Schaapherder, Alexander F. ;
Witteman, Ben J. ;
Ploeg, Rutger J. ;
van Goor, Harry ;
van Laarhoven, Cornelis J. ;
Tan, Adriaan C. ;
Brink, Menno A. ;
van der Harst, Erwin ;
Wahab, Peter J. ;
van Eijck, Casper H. ;
Dejong, Cornelis H. ;
van Erpecum, Karel J. ;
Akkermans, Louis M. ;
Gooszen, Hein G. .
ANNALS OF SURGERY, 2009, 250 (05) :712-719
[4]   Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial [J].
Besselink, Marc G. H. ;
van Santvoort, Hjalmar C. ;
Buskens, Erik ;
Boermeester, Marja A. ;
van Goor, Harry ;
Timmerman, Harro M. ;
Nieuwenhuijs, Vincent B. ;
Bollen, Thomas L. ;
van Ramshorst, Bert ;
Witteman, Ben J. M. ;
Rosman, Camiel ;
Ploeg, Rutger J. ;
Brink, Menno A. ;
Schaapherder, Alexander F. M. ;
Dejong, Cornelis H. C. ;
Wahab, Peter J. ;
van Laarhoven, Cees J. H. M. ;
van der Harst, Erwin ;
van Eijck, Casper H. J. ;
Cuesta, Miguel A. ;
Akkermans, Louis M. A. ;
Gooszen, Hein G. .
LANCET, 2008, 371 (9613) :651-659
[5]   DEFINITIONS FOR SEPSIS AND ORGAN FAILURE AND GUIDELINES FOR THE USE OF INNOVATIVE THERAPIES IN SEPSIS [J].
BONE, RC ;
BALK, RA ;
CERRA, FB ;
DELLINGER, RP ;
FEIN, AM ;
KNAUS, WA ;
SCHEIN, RMH ;
SIBBALD, WJ .
CHEST, 1992, 101 (06) :1644-1655
[6]   The international sepsis forum consensus conference on definitions of infection in the intensive care unit [J].
Calandra, T ;
Cohen, J .
CRITICAL CARE MEDICINE, 2005, 33 (07) :1538-1548
[7]   Oral probiotic and prevention of Pseudomonas aeruginosa infections:: a randomized, double-blind, placebo-controlled pilot study in intensive care unit patients [J].
Forestier, Christiane ;
Guelon, Dominique ;
Cluytens, Valerie ;
Gillart, Thierry ;
Sirot, Jacques ;
De Champs, Christophe .
CRITICAL CARE, 2008, 12 (03)
[8]   Probiotics for preventing and treating nosocomial infections - Review of current evidence and recommendations [J].
Isakow, Warren ;
Morrow, Lee E. ;
Kollef, Marin H. .
CHEST, 2007, 132 (01) :286-294
[9]   Influence of synbiotic containing Lactobacillus acidophilus La5, Bifidobacterium lactis Bb 12, Streptococcus thermophilus, Lactobacillus bulgaricus and oligofructose on gut barrier function and sepsis in critically ill patients:: A randomised controlled trial [J].
Jain, PK ;
McNaught, CE ;
Anderson, ADG ;
MacFie, J ;
Mitchell, CJ .
CLINICAL NUTRITION, 2004, 23 (04) :467-475
[10]   Benefits of a synbiotic formula (Synbiotic 2000Forte®) in critically ill trauma patients:: Early results of a randomized controlled trial [J].
Kotzampassi, Katerina ;
Giamarellos-Bourboulis, Evagellos J. ;
Voudouris, Antonios ;
Kazamias, Pantelis ;
Eleftheriadis, Efthimios .
WORLD JOURNAL OF SURGERY, 2006, 30 (10) :1848-1855