臨時呼吸器関連肺炎におけるプロバイオティクスの効果: ランダム化臨床試験
Jennie Johnstone1, Maureen Meade2, François Lauzier3
1University of Toronto, Toronto, Canada.
JAMA
|September 21, 2021
まとめ
微生物 Lactobacillus rhamnosus GGは重症患者の呼吸器関連肺炎 (VAP) を有意に減少させなかった. この研究では,効果は認められず,有害事象のリスクが増加した可能性があるため,この集団での使用は疑問視されています.
科学分野:
- クリティカル ケア 医療
- 微生物群の研究
- 感染症
背景:
- 微生物不活性化症は重篤な病気で 懸念が高まっています
- プロバイオティクスは,微生物群の改変と感染予防のために研究されています.
- 以前の研究では,プロバイオティクスが呼吸器関連肺炎 (VAP) などの感染症を軽減することが示唆されているが,プロバイオティクスの関連感染も指摘されている.
研究 の 目的:
- VAPを予防するLactobacillus rhamnosus GGの有効性を評価する.
- L rhamnosus GGがICUで発症する他の感染症に与える影響を評価する.
- 死亡率と滞在期間を含む追加の臨床結果への影響を決定する.
主な方法:
- 44のICUで2653人の成人を対象としたランダム化プラセボ対照試験です.
- 患者は少なくとも72時間以上 機械呼吸器を必要とすると予測された.
- 介入は,L rhamnosus GGまたはプラセボを1日2回腸内投与することでした.
主要な成果:
- プロバイオティクスのグループ (21. 9%) とプラセボのグループ (21. 3%) の間でVAPの発生率に有意な違いはありません.
- 他の感染症,抗菌薬の使用,または死亡率を含む二次的なアウトカムにおいて,有意な差異は観察されなかった.
- プロバイオティクスを投与したグループでは,不妊または不妊の部位でL rhamnosusに関連した有害事象の統計的に有意な増加が認められた.
結論:
- Lactobacillus rhamnosus GGの投与は,重症で機械呼吸器を使用している患者のVAPの発生率を減少させなかった.
- これらの結果は,この患者集団におけるVAPまたは他の感染症の予防のためにLrhamnosus GGの使用を支持しません.
- 重症患者のプロバイオティクスの使用については,注意が必要である.
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