@article{3033825,
    title = "A four-probiotic preparation for ventilator-associated pneumonia in
multi-trauma patients: results of a randomized clinical trial",
    author = "Tsilika, Maria and Thoma, Giannoula and Aidoni, Zoi and Tsaousi, Georgia and and Fotiadis, Kyriakos and Stavrou, George and Malliou, Petra and and Chorti, Angeliki and Massa, Helen and Antypa, Elli and Vasiliadou, and Georgia and Pagdatoglou, Kyriaki and Voudouris, Antonios and Vasiliagou, and Spyridoula and Mitos, Giakoumis and Kontopoulou, Ntina and Paraforou, and Niki and Antoniadou, Eleni and Mouloudi, Helen and Gkeka, Eleni and and Grosomanidis, Vasilis and Giamarellos-Bourboulis, Evangelos J. and and Kotzampassi, Katerina",
    journal = "International Journal of Antimicrobial Agents",
    year = "2022",
    volume = "59",
    number = "1",
    publisher = "Elsevier",
    issn = "0924-8579",
    doi = "10.1016/j.ijantimicag.2021.106471",
    keywords = "Probiotics; Mechanical ventilation; Pneumonia; Sepsis; Safety;
Oropharynx",
    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
x10(9) colony-forming units (cfu)], Lactobacillus plantarum (0.5 x10(9)
cfu), Bifidobacterium lactis BB-12 (1.75 x109 cfu) and Saccharomyces
boulardii (1.5 x10(9) 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. (C) 2021 The Authors. Published by Elsevier Ltd."
}