Probiotics May Reduce Ventilator-Associated Pneumonia

Enterally administered probiotic treatment with Lactobacillus rhamnosus GG can cut the rate of ventilator-associated pneumonia (VAP) in high-risk patients, according to a new pilot study.

Researchers at Creighton University School of Medicine (Omaha, NE, USA) performed a prospective, randomized, double blind, placebo-controlled trial involving 146 mechanically ventilated patients who were considered at high risk of developing VAP. The patients were randomly assigned to receive either enteral probiotics (68 patients) that were suspended in sterile, water-based surgical lubricant applied as slurry to the oropharynx, as well as mixed in sterile water and given through the nasogastric tube. The placebo control group (70 patients) was treated with an inert plant starch inulin that was similarly administered. Treatment started within 24 hours of intubation.

The researchers found that the patients treated with Lactobacillus were significantly less likely to develop microbiologically confirmed VAP (19.1%), when compared to patients treated with placebo (40%). And although probiotic treated patients had significantly less Clostridium difficile associated diarrhea than placebo treated patients, the duration of diarrhea per episode was similar between the two groups, and the probiotic treated cohort had fewer days of antibiotics prescribed for VAP and for Clostridium difficile associated diarrhea. No adverse events related to probiotic administration were identified. The study was published early online on June 3, 2010, in the American Journal of Respiratory and Critical Care Medicine.

"Lactobacillus may represent a novel, inexpensive, and nonantibiotic approach to prevention of nosocomial infections in properly selected ICU patients,” concluded lead author Lee Morrow, M.D., and colleagues of the department of internal medicine. "We are also proposing a larger, multicenter study wherein the criteria for study entry would be liberalized, thereby giving a more real-world assessment of the utility of probiotics for routine VAP prophylaxis in the ICU.”

There is general agreement that benefits of probiotics are primarily seen through four primary avenues: competition of probiotics with pathogens for key nutrients; interactions of probiotics with the surfaces of the host organism in a manner that reduces the ability of microbes to penetrate into the host's body; probiotic secretion of various substances that create unfavorable conditions for the growth of pathogens; and probiotic stimulation of the host's immune system in a manner that maintains the ability of the immune system to resist infections, called immunomodulation.

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Creighton University School of Medicine