益生菌对严重病患的呼吸机相关肺炎的影响:随机临床试验
Jennie Johnstone1, Maureen Meade2, François Lauzier3
1University of Toronto, Toronto, Canada.
JAMA
|September 21, 2021
概括
在重症患者中,益生菌Lactobacillus rhamnosus GG没有显著降低呼吸器相关的肺炎 (VAP). 这项研究没有发现任何益处,并且可能增加不良事件的风险,因此对该群体的使用提出了质疑.
科学领域:
- 危急护理医学
- 微生物组研究
- 传染性疾病
背景情况:
- 微生物失调症是严重疾病中越来越令人担忧的.
- 益生菌正在研究微生物组修饰和预防感染.
- 之前的研究表明益生菌可以减少呼吸器相关的肺炎 (VAP),但也注意到益生菌相关的感染.
研究的目的:
- 评估 Lactobacillus rhamnosus GG 在预防 VAP 的有效性.
- 评估Lrhamnosus GG对其他在ICU获得的感染的影响.
- 确定对其他临床结果的影响,包括死亡率和停留时间.
主要方法:
- 一个随机的,安慰剂对照试验,涉及44个ICU的2653名成年患者.
- 预计患者需要机械呼吸至少72小时.
- 干预包括每天两次通过肠道给予Lrhamnosus GG或安慰剂.
主要成果:
- 在益生菌组 (21. 9%) 和安慰剂组 (21. 3%) 之间,VAP发生率没有显著差异.
- 在二次结果 (包括其他感染,抗菌剂使用或死亡率) 中没有发现显著差异.
- 在益生菌组中,在无菌或非无菌部位中,与Lrhamnosus相关的不良事件的统计显著增加.
结论:
- 在危急病的机械呼吸患者中,施用Lactobacillus rhamnosus GG并没有降低VAP的发生率.
- 这些发现不支持使用Lrhamnosus GG来预防VAP或其他感染.
- 观察到的不良事件的增加使得在重症患者中使用益生菌需要谨慎.
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