Probiotic, prebiotic, and synbiotic use in critically ill patients

Area of Science:

• Microbiology
• Critical Care Medicine
• Gastroenterology

Background:

• Probiotics, prebiotics, and synbiotics are increasingly explored for their therapeutic potential.
• Gut microbiome modulation is a key focus in managing intensive care unit (ICU) patient health.
• Antibiotic resistance necessitates novel approaches to prevent and treat nosocomial infections.

Purpose of the Study:

• To review and summarize current data on the use of probiotics, prebiotics, and synbiotics in ICU settings.
• To evaluate the efficacy and safety of these interventions in specific ICU-related disorders.

Main Methods:

• Systematic reviews and meta-analyses of existing primary data were analyzed.
• Data fragmentation and limitations in primary studies were acknowledged.

Main Results:

• Probiotics demonstrate potential benefits in managing antibiotic-associated diarrhea, ventilator-associated pneumonia, and necrotizing enterocolitis in ICU patients.
• Mechanisms include enhanced gastrointestinal barrier function, gut flora modification, and immunomodulation.
• Existing studies exhibit heterogeneity in probiotic strains, dosages, and administration duration, with small sample sizes.

Conclusions:

• Probiotics are generally well-tolerated with rare adverse events, but safety monitoring is crucial, as highlighted by the PROPATRIA trial.
• Further research is essential to identify optimal probiotic characteristics and understand mechanisms of action for various disorders.
• Non-antibiotic strategies like probiotics are gaining importance in combating nosocomial infections.