Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials
Abstract
BACKGROUND: Previous reviews showed no benefit for the administration of probiotics in critically ill patients, but they did not focus on ventilator-associated pneumonia. DESIGN: Meta-analysis of randomized controlled trials comparing probiotics and control in patients undergoing mechanical ventilation and reporting on incidence of ventilator-associated pneumonia. METHODS: PubMed, Scopus, Current Contents, Cochrane Central Register of Controlled Trials, and reference lists were searched. Weighted mean differences, pooled odds ratios, and 95% confidence intervals were calculated, implementing both the Mantel-Haenszel fixed effect and the DerSimonian-Laird random effects model. RESULTS: Five randomized controlled trials were included. Administration of probiotics, compared with control, was beneficial in terms of incidence of ventilator-associated pneumonia (689 patients; fixed effect model: odds ratio, 0.61; 95% confidence interval, 0.41-0.91; random effects model: odds ratio, 0.55, 95% confidence interval, 0.31-0.98), length of intensive care unit stay (fixed effect model: weighted mean difference, -0.99 days; 95% confidence interval, -1.37--0.61), and colonization of the respiratory tract with Pseudomonas aeruginosa (odds ratio, 0.35; 95% confidence interval, 0.13-0.93). However, no difference was revealed between comparators regarding intensive care unit mortality (odds ratio, 0.75; 95% confidence interval, 0.47-1.21), in-hospital mortality (odds ratio, 0.75; 95% confidence interval, 0.46-1.24), duration of mechanical ventilation (weighted mean difference, -0.01 days; 95% confidence interval, -0.31--0.29), and diarrhea (odds ratio, 0.61; 95% confidence interval, 0.28-1.34). CONCLUSION: Administration of probiotics is associated with lower incidence of ventilator-associated pneumonia than control. Given the increasing antimicrobial resistance, this promising strategy deserves consideration in future studies, which should have active surveillance for probiotic-induced diseases.
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Early intensive-care studies of probiotics suggest that they decrease the risk of pneumonia and shorten the length of stay in the intensive-care unit for ventilated patients and decrease systemic infections in high-risk postoperative patients.
“Early intensive-care studies of probiotics suggest that they decrease the risk of pneumonia and shorten the length of stay in the intensive-care unit for ventilated patients150 and decrease systemic infections in high-risk postoperative patients.”
From The microbiome and critical illness (2016) · cites this paper as [150]
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- Authors
- Siempos, I. I., Ntaidou, T. K., & Falagas, M. E.
- Affiliations
- Tufts University (US)
- ORCID
- Falagas, Matthew E.
- Venue
- Critical Care Medicine
- Published
- 2010-03
- Volume
- 38
- Issue
- 3
- Pages
- 954-962
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W1990533469
- Cited by
- 204
- References
- 34
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 8 · 2023: 8 · 2022: 13 · 2021: 7 · 2020: 8 · 2019: 7 · 2018: 3 · 2017: 8 · 2016: 12 · 2015: 25 · 2014: 16 · 2013: 20 · 2012: 24
- FWCI
- 3.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- probiotics, ventilator-associated pneumonia, mechanical ventilation, critically ill patients, Pseudomonas aeruginosa colonization, ICU length of stay, mortality, diarrhea, antimicrobial resistance
- MeSH terms
- Critical Care, Humans, Pseudomonas aeruginosa, Pseudomonas Infections, Randomized Controlled Trials as Topic, Hospital Mortality, Probiotics, Pneumonia, Ventilator-Associated
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