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Published on: January 27, 2019
Randomized controlled study of probiotics containing Lactobacillus casei (Shirota strain) for prevention of
Insights
Probiotics containing Lactobacillus casei (Shirota strain) showed a trend in reducing ventilator-associated pneumonia (VAP) and resistant bacteria colonization in medical patients. Further research is needed to confirm these findings and their clinical significance.
Area of Science:
- Critical Care Medicine
- Microbiology
- Gastroenterology
Background:
- Ventilator-associated pneumonia (VAP) is a significant complication in mechanically ventilated patients.
- Probiotics have emerged as a potential strategy to modulate the gut microbiome and prevent infections.
Purpose of the Study:
- To investigate the efficacy of Lactobacillus casei (Shirota strain) in reducing VAP incidence.
- To assess the impact of probiotics on resistant bacteria colonization and clinical outcomes in mechanically ventilated patients.
Main Methods:
- A prospective, randomized, open-label controlled trial involving 150 adult patients requiring mechanical ventilation.
- Patients received either Lactobacillus casei (Shirota strain) or a control, alongside standard care.
- Primary outcomes included VAP incidence and incidence rate; secondary outcomes covered mortality, hospital stay, diarrhea, and bacterial colonization.
Main Results:
- While not statistically significant, the probiotics group showed a lower incidence of VAP (24% vs. 29.3%) and VAP rate (22.64 vs. 30.22 per 1,000 ventilator-days).
- A trend towards reduced colonization with resistant bacteria in the oropharynx was observed in the probiotic group.
- No significant differences were found in mortality or length of hospital stay between groups.
Conclusions:
- Lactobacillus casei (Shirota strain) may have a beneficial role in reducing VAP incidence and oropharyngeal resistant bacteria colonization.
- The study suggests a potential, though not statistically significant, benefit of probiotics in this patient population.
- Further investigation is warranted to confirm these preliminary findings and explore optimal probiotic strategies.
Objective:
To evaluate the efficacy ofprobiotics, Lactobacillus casei (Shirvta strain), in reducing the incidence ofventilator- associated pneumonia (VAP) in medical patients who received mechanical ventilation at Siriraj Hospital.
Material And Method:
A prospective, randomized, open-label controlled trial was conducted in 150 adult hospitalized patients in medical wards who were expected to receive mechanical ventilation for 72 hours or longer: The patients were randomized to the probiotics group or the control group. All patients received regular care for mechanical ventilation. The patients in the probiotics group received 80 ml of Lactobacillus casei (Shirota strain) for oral care after having standard oral care once daily and additional 80 ml of the aforementionedfermented dairy product was given via enteralfeeding once daily. The primary outcomes were incidence of VAP and incidence rate of VAP episodes per 1,000 ventilator-days. The secondary outcomes were length ofhospital stay, mortality at day 28 and 90, incidence ofdiarrhea, andpresence of resistant bacteria in oropharyngeal and rectal swab samples taken from the patients at baseline, day 7 and day 28 after enrollment.
Results:
The baseline characteristics of the patients in the probiotics group (75) and the control group (75) were not significantly different. The patients in the probiotics group were less likely to develop VAP compared with the control group (24% vs. 29.3%, p = 0.46), respectively. The incidence rates of VAP in the probiotics and control groups were 22.64 and 30.22 episodes per 1,000 ventilator-days, respectively (p = 0.37). A trend of lower prevalence of some resistant bacteria cultured from oropharyngeal swabs in the probiotics group than that in the control group was observed. Overall 28- and 90-day mortality and length of hospital stay of the patients in both groups were not significantly different.
Conclusion:
Administration of probiotics containing Lactobacillus casei (Shirota strain) has a tendency to reduce the incidence of VAP and colonization with resistant bacteria in oropharyngeal cavity without significant effects on mortality and length of hospital stay.
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