Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials
- Burns & Trauma Vol. 10, Issue 1, (2022)
- 作者机构：
1. University of Electronic Science and Technology of China
2. Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women’s and children’s Hospital of Chengdu Medical College
- 作者简介：
- 基金信息：
DOI：10.1093/burnst/tkac004
CLC：Published：2022，
Published Online：14 March 2022，
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Kai Wang, Qin Zeng, Ke-xun Li, Yu Wang, Lu Wang, Ming-wei Sun, Jun Zeng, Hua Jiang, Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials, Burns & Trauma, Volume 10, 2022, tkac004, https://doi.org/10.1093/burnst/tkac004
Kai Wang, Qin Zeng, Ke-xun Li, Yu Wang, Lu Wang, Ming-wei Sun, Jun Zeng, Hua Jiang, Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials, Burns & Trauma, Volume 10, 2022, tkac004, https://doi.org/10.1093/burnst/tkac004 DOI：
摘要
Abstract
BackgroundMicrobial dysbiosis in critically ill patients is a leading cause of mortality and septic complications. Probiotics and synbiotics have emerged as novel therapy on gut microbiota to prevent septic complications. However
current evidence on their effects is conflicting. This work aims to systematically review the impact of probiotics or synbiotics in critically ill adult patients.MethodsA comprehensive search of the PubMed
CBM
Embase
CENTRAL
ISI
and CNKI databases was performed to identify randomized controlled trials that evaluate probiotics or synbiotics in critically ill patients. The quality assessment was based on the modified Jadad's score scale and the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The major outcome measure was mortality. Secondary outcomes included incidence of septic complications
sepsis incidence
length of intensive care unit (ICU) stay
incidence of non-septic complication
and ventilator day. Data synthesis was conduct by Review Manager 5.4.ResultsA total of 25 randomized controlled trials reporting on 5049 critically ill patients were included. In the intervention group
2520 participants received probiotics or synbiotics
whereas 2529 participants received standard care or placebo. Pooling data from randomized controlled trials demonstrated a significant reduction in the incidence of ventilator-associated pneumonia (VAP) in the treatment group [(risk ratio (RR) 0.86; 95% confidence interval (CI): 0.78–0.95; p < 0.003
I2 = 85%)]. However
in the subgroup analysis
the reduction of incidence of VAP was only significant in patients receiving synbiotics (RR = 0.61
95% CI: 0.47–0.80
p = 0.0004
I2 = 40%) and not significant in those receiving only probiotics (RR = 0.91
95% CI: 0.82–1.01
p = 0.07
I2 = 65%). Moreover
sepsis incidence of critically ill patients was only significantly reduced by the addition of synbiotics (RR = 0.41; 95% CI: 0.22–0.72
p = 0.005
I2 = 0%). The incidence of ICU-acquired infections was significantly reduced by the synbiotics therapy (RR = 0.72; 95% CI: 0.58–0.89
p = 0.0007
I2 = 79%). There was no significant difference in mortality
diarrhea
or length of ICU stay between the treatment and control groups.ConclusionsSynbiotics is an effective and safe nutrition therapy in reducing septic complications in critically ill patients. However
in such patients
administration of probiotics alone compared with placebo resulted in no difference in the septic complications.
关键词
Keywords
Critically ill patientsProbioticsSynbioticsMeta-analysisSystematic reviewMortalityVentilator-associated pneumonia
references
1.Clark JA, Coopersmith CM. Intestinal crosstalk: a new paradigm for understanding the gut as the ``motor'' of critical illness. Shock. 2007;28:384–93.
2.Bateman BT, Schmidt U, Berman MF, Bittner EA. Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample. Anesthesiology. 2010;112:917–25.
3.Martin GS, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–54.
4.Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006;25:210–23.
5.Biancone L, Monteleone I, Del Vecchio BG, Vavassori P, Pallone F. Resident bacterial flora and immune system. Dig Liver Dis. 2002;34:S37–43.
6.Fooks LJ, Gibson GR. Probiotics as modulators of the gut flora. Br J Nutr. 2002;88:S39–49.
7.Roberfroid M, Gibson GR, Hoyles L, McCartney AL, Rastall R, Rowland I, et al. Prebiotic effects: metabolic and health benefits. Br J Nutr. 2010;104:S1–63.
8.Sarkar A, Lehto SM, Harty S, Dinan TG, Cryan JF, Burnet PWJ. Psychobiotics and the manipulation of bacteria-gut-brain signals. Trends Neurosci. 2016;39:763–81.
9.Chowdhury AH, Adiamah A, Kushairi A, Varadhan KK, Krznaric Z, Kulkarni AD, et al. Perioperative probiotics or Synbiotics in adults undergoing elective abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2020;271:1036–47.
10.Wu XD, Liu MM, Liang X, Hu N, Huang W. Effects of perioperative supplementation with pro−/synbiotics on clinical outcomes in surgical patients: a meta-analysis with trial sequential analysis of randomized controlled trials. Clin Nutr. 2018;37:505–15.
11.Shimizu K, Ogura H, Asahara T, Nomoto K, Morotomi M, Tasaki O, et al. Probiotic/synbiotic therapy for treating critically ill patients from a gut microbiota perspective. Dig Dis Sci. 2013;58:23–32.
12.Shimizu K, Ogura H, Goto M, Asahara T, Nomoto K, Morotomi M, et al. Synbiotics decrease the incidence of septic complications in patients with severe SIRS: a preliminary report. Dig Dis Sci. 2009;54:1071–8.
13.Chakraborty RK, Burns B. Systemic Inflammatory Response Syndrome. Treasure Island (FL):StatPearls, 2021, StatPearls [Internet].
14.Shimizu K, Yamada T, Ogura H, Mohri T, Kiguchi T, Fujimi S, et al. Synbiotics modulate gut microbiota and reduce enteritis and ventilator-associated pneumonia in patients with sepsis: a randomized controlled trial. Crit Care. 2018;22:239.
15.Zeng J, Wang CT, Zhang FS, Qi F, Wang SF, Ma S, 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;42:1018–28.
16.Hempel S, Newberry S, Ruelaz A, Wang Z, Miles JN, Suttorp MJ, et al. Safety of probiotics used to reduce risk and prevent or treat disease. Evid Rep Technol Assess (Full Rep). 2011;200:1–645.
17.Bafeta A, Koh M, Riveros C, Ravaud P. Harms reporting in randomized controlled trials of interventions aimed at modifying microbiota: a systematic review. Ann Intern Med. 2018;169:240–7.
18.Johnstone J, Meade M, Lauzier F, Marshall J, Duan E, Dionne J, et al. Effect of probiotics on incident ventilator-associated pneumonia in critically ill patients: a randomized clinical trial. JAMA. 2021;326:1024–33.
19.Mahmoodpoor A, Hamishehkar H, Asghari R, Abri R, Shadvar K, Sanaie S. Effect of a probiotic preparation on ventilator-associated pneumonia in critically ill patients admitted to the intensive care unit: a prospective double-blind randomized controlled trial. Nutr Clin Pract. 2019;34:156–62.
20.JPT H. Cochrane Handbook for systematic reviews of Interventions version 5.0.1. www.Cochrane-handbook.org.The Cochrane Collaboration, 2008.
21.Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.
22.Min G, Liu F, Zhai S, Zhu JS, Zhang H, Wang T. Salbutamol in preventing preterm labour: a systematic review. Chin J Evid-based Med. 2007;7:591–600.
23.Schwarzer G. Meta: Meta-Analysis with R.R package version 3.7–0. http://CRAN.R-project.org/package=meta. 2014.
24.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.
25.Alberda C, Gramlich L, Meddings J, Field C, McCargar L, Kutsogiannis D, et al. Effects of probiotic therapy in critically ill patients: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2007;85:816–23.
26.Falcao de Arruda IS, de Aguilar-Nascimento JE. Benefits of early enteral nutrition with glutamine and probiotics in brain injury patients. Clin Sci (Lond). 2004;106:287–92.
27.Barraud D, Blard C, Hein F, Marcon O, Cravoisy A, Nace L, et al. Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial. Intensive Care Med. 2010;36:1540–7.
28.Bleichner G, Blehaut H, Mentec H, Moyse D. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med. 1997;23:517–23.
29.Ferrie SDM. Lactobacillus GG as treatment for diarrhea during enteral feeding in critical illness: randomized controlled trial. JPEN J Parenter Enteral Nutr. 2011;35:43–9.
30.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.
31.Frohmader TJ, Chaboyer WP, Robertson IK, Gowardman J. Decrease in frequency of liquid stool in enterally fed critically ill patients given the multispecies probiotic VSL#3: a pilot trial. Am J Crit Care. 2010;19:e1–11.
32.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;67:815–21.
33.Jain PK, McNaught CE, Anderson AD, MacFie J, Mitchell CJ. 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. Clin Nutr. 2004;23:467–75.
34.Klarin B, Johansson ML, Molin G, Larsson A, Jeppsson B. Adhesion of the probiotic bacterium lactobacillus plantarum 299v onto the gut mucosa in critically ill patients: a randomised open trial. Crit Care. 2005;9:R285–93.
35.Klarin BMG, Jeppsson B. 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.
36.Knight DJ, Gardiner D, Banks A, Snape SE, Weston VC, Bengmark S, 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;35:854–61.
37.Kotzampassi K, Giamarellos-Bourboulis EJ, Voudouris A, Kazamias 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;30:1848–55.
38.Litton E, Anstey M, Broadhurst D, Chapman A, Currie A, Ferrier J, et al. Early and sustained lactobacillus plantarum probiotic therapy in critical illness: the randomised, placebo-controlled, restoration of gut microflora in critical illness trial (ROCIT). Intensive Care Med. 2021;47:307–15.
39.Ismael Lopez de Toro MC, Marcelino SC, SB MJP-P, Torrijos PL-R, Pilar SR, Ana RC, et al. Influencia de los simbio’ticos en la disfuncio’n multiorga’nica: ensayo aleatorizado y controlado. Med Clin (Barc). 2014;143:161–2.
40.McNaught CE, Woodcock NP, Anderson AD, MacFie J. A prospective randomised trial of probiotics in critically ill patients. Clin Nutr. 2005;24:211–9.
41.Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am J Respir Crit Care Med. 2010;182:1058–64.
42.Rongrungruang Y, Krajangwittaya D, Pholtawornkulchai K, Tiengrim S, Thamlikitkul V. Randomized controlled study of probiotics containing lactobacillus casei (Shirota strain) for prevention of ventilator-associated pneumonia. J Med Assoc Thail. 2015;98:253–9.
43.Sanaie S, Ebrahimi-Mameghani M, Hamishehkar H, Mojtahedzadeh M, Mahmoodpoor A. Effect of a multispecies probiotic on inflammatory markers in critically ill patients: a randomized, double-blind, placebo-controlled trial. J Res Med Sci. 2014;19:827–33.
44.Spindler-Vesel A, Bengmark S, Vovk I, Cerovic O, Kompan L. Synbiotics, prebiotics, glutamine, or peptide in early enteral nutrition: a randomized study in trauma patients. JPEN J Parenter Enteral Nutr. 2007;31:119–26.
45.Tan M, Zhu JC, Du J, Zhang LM, Yin HH. 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:R290.
46.Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit Care. 2016;19:262.
47.Whelan K, Myers CE. Safety of probiotics in patients receiving nutritional support: a systematic review of case reports, randomized controlled trials, and nonrandomized trials. Am J Clin Nutr. 2010;91:687–703.
48.Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;371:651–9.
49.Suez J, Zmora N, Zilberman-Schapira G, Mor U, Dori-Bachash M, Bashiardes S, et al. Post-antibiotic gut mucosal microbiome reconstitution is impaired by probiotics and improved by autologous FMT. Cell. 2018;174:1406–23.
50.Fruhwald S, Holzer P, Metzler H. Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact. Intensive Care Med. 2007;33:36–44.
51.Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The nutritional and metabolic working Group of the Spanish Society of intensive care medicine and coronary units. Crit Care Med. 1999;27:1447–53.
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