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Efecto de los probióticos en la neumonía asociada al ventilador en pacientes críticos: un ensayo clínico aleatorizado
Jennie Johnstone1, Maureen Meade2, François Lauzier3
1University of Toronto, Toronto, Canada.
JAMA
|September 21, 2021
Resumen
El probiótico Lactobacillus rhamnosus GG no redujo significativamente la neumonía asociada al ventilador en pacientes en estado crítico. El estudio no encontró ningún beneficio y un potencial aumento del riesgo de eventos adversos, poniendo en duda su uso en esta población.
Área de la Ciencia:
- Medicina de cuidados intensivos
- Investigación del microbioma
- Enfermedades infecciosas
Sus antecedentes:
- La disbiosis microbiana es una preocupación creciente en la enfermedad crítica.
- Los probióticos se están investigando para la modificación del microbioma y la prevención de infecciones.
- Estudios anteriores sugieren que los probióticos pueden reducir las infecciones como la neumonía asociada al ventilador (VAP), pero también se han observado infecciones asociadas a los probióticos.
Objetivo del estudio:
- Evaluar la eficacia de Lactobacillus rhamnosus GG en la prevención del VAP.
- Evaluar el impacto de L rhamnosus GG en otras infecciones adquiridas en UCI.
- Determinar el efecto en resultados clínicos adicionales, incluida la mortalidad y la duración de la estancia.
Principales métodos:
- Un ensayo aleatorizado controlado con placebo en el que participaron 2653 pacientes adultos en 44 unidades de cuidados intensivos.
- Se predijo que los pacientes requerirían ventilación mecánica durante al menos 72 horas.
- La intervención consistió en la administración enteral de L rhamnosus GG o placebo dos veces al día.
Principales resultados:
- No hubo diferencias significativas en la incidencia de VAP entre el grupo de probióticos (21,9%) y el grupo de placebo (21,3%).
- No se observaron diferencias significativas en los resultados secundarios, incluidas otras infecciones, uso de antimicrobianos o mortalidad.
- Se observó un aumento estadísticamente significativo de los eventos adversos relacionados con L rhamnosus en sitios estériles o no estériles en el grupo de probióticos.
Conclusiones:
- La administración de Lactobacillus rhamnosus GG no redujo la incidencia de PAV en pacientes en estado crítico con ventilación mecánica.
- Los hallazgos no apoyan el uso de L rhamnosus GG para la prevención de VAP u otras infecciones en esta población de pacientes.
- El aumento observado en los eventos adversos justifica la precaución con respecto al uso de probióticos en pacientes en estado crítico.
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