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A four-probiotic preparation for ventilator-associated pneumonia in multi-trauma patients: results of a randomized clinical trial.
Tsilika, Maria; Thoma, Giannoula; Aidoni, Zoi; Tsaousi, Georgia; Fotiadis, Kyriakos; Stavrou, George; Malliou, Petra; Chorti, Angeliki; Massa, Helen; Antypa, Elli; Vasiliadou, Georgia; Pagdatoglou, Kyriaki; Voudouris, Antonios; Vasiliagou, Spyridoula; Mitos, Giakoumis; Kontopoulou, Ntina; Paraforou, Niki; Antoniadou, Eleni; Mouloudi, Helen; Gkeka, Eleni; Grosomanidis, Vasilis; Giamarellos-Bourboulis, Evangelos J; Kotzampassi, Katerina.
  • Tsilika M; 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
  • Thoma G; Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece.
  • Aidoni Z; Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece.
  • Tsaousi G; Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece.
  • Fotiadis K; Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece.
  • Stavrou G; Department of Surgery, Aristotle University of Thessaloniki, Greece.
  • Malliou P; Department of Surgery, Aristotle University of Thessaloniki, Greece.
  • Chorti A; Department of Surgery, Aristotle University of Thessaloniki, Greece.
  • Massa H; Intensive Care Unit, Ippokrateion General Hospital, Thessaloniki, Greece.
  • Antypa E; Intensive Care Unit, Georgios Gennimatas General Hospital, Thessaloniki, Greece.
  • Vasiliadou G; Intensive Care Unit, George Papanikolaou General Hospital, Thessaloniki, Greece.
  • Pagdatoglou K; Intensive Care Unit, Trikala General Hospital, Trikala, Greece.
  • Voudouris A; Intensive Care Unit, Aghios Pavlos General Hospital, Thessaloniki, Greece.
  • Vasiliagou S; Department of Surgery, Aristotle University of Thessaloniki, Greece.
  • Mitos G; Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece.
  • Kontopoulou N; Intensive Care Unit, Georgios Gennimatas General Hospital, Thessaloniki, Greece.
  • Paraforou N; Intensive Care Unit, Trikala General Hospital, Trikala, Greece.
  • Antoniadou E; Intensive Care Unit, Georgios Gennimatas General Hospital, Thessaloniki, Greece.
  • Mouloudi H; Intensive Care Unit, Ippokrateion General Hospital, Thessaloniki, Greece.
  • Gkeka E; Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece.
  • Grosomanidis V; Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece.
  • Giamarellos-Bourboulis EJ; 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece. Electronic address: egiamarel@med.uoa.gr.
  • Kotzampassi K; Department of Surgery, Aristotle University of Thessaloniki, Greece.
Int J Antimicrob Agents ; 59(1): 106471, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1487080
ABSTRACT
The role of probiotics in the prevention of ventilator-associated pneumonia (VAP) remains inconclusive. The aim of this study was to assess the efficacy of a probiotic regimen for VAP prophylaxis in mechanically ventilated multi-trauma patients, intubated immediately after the injurious insult. In a randomized, placebo-controlled study enrolling multi-trauma patients, patients expected to require mechanical ventilation for >10 days were assigned at random to receive prophylaxis with a probiotic formula (n=59) or placebo (n=53). The probiotic formula was a preparation of Lactobacillus acidophilus LA-5 [1.75 × 109 colony-forming units (cfu)], Lactobacillus plantarum (0.5 × 109 cfu), Bifidobacterium lactis BB-12 (1.75 × 109 cfu) and Saccharomyces boulardii (1.5 × 109 cfu) in sachets. Each patient received two sachets twice daily for 15 days one through the nasogastric tube and one spread on the oropharynx. The incidence of VAP was the primary endpoint. The incidence of other infections and sepsis, and the duration of hospital stay were the secondary endpoints. Administration of probiotics reduced the incidence of VAP [11.9% vs 28.3%, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.13-0.92; P=0.034] and sepsis [6.8% vs 24.5%, odds ratio 0.22, 95% CI 0.07-0.74 P=0.016]. Furthermore, probiotic prophylaxis reduced the time of stay in the intensive care unit (ICU) and the length of hospital stay. The prophylactic use of probiotics with a combination of enteral and topical application to the oropharynx had a positive effect on the incidence of VAP and sepsis, as well as on ICU and total hospital stay in patients receiving protracted mechanical ventilation.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antibiotic Prophylaxis / Probiotics / Lactobacillus plantarum / Pneumonia, Ventilator-Associated / Saccharomyces boulardii / Bifidobacterium animalis / Lactobacillus acidophilus Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Int J Antimicrob Agents Year: 2022 Document Type: Article Affiliation country: J.ijantimicag.2021.106471

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antibiotic Prophylaxis / Probiotics / Lactobacillus plantarum / Pneumonia, Ventilator-Associated / Saccharomyces boulardii / Bifidobacterium animalis / Lactobacillus acidophilus Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Int J Antimicrob Agents Year: 2022 Document Type: Article Affiliation country: J.ijantimicag.2021.106471