TY - JOUR
TI - A four-probiotic preparation for ventilator-associated pneumonia in
multi-trauma patients: results of a randomized clinical trial
AU - Tsilika, Maria
AU - Thoma, Giannoula
AU - Aidoni, Zoi
AU - Tsaousi, Georgia
AU - and Fotiadis, Kyriakos
AU - Stavrou, George
AU - Malliou, Petra and
AU - Chorti, Angeliki
AU - Massa, Helen
AU - Antypa, Elli
AU - Vasiliadou,
AU - Georgia
AU - Pagdatoglou, Kyriaki
AU - Voudouris, Antonios
AU - Vasiliagou,
AU - Spyridoula
AU - Mitos, Giakoumis
AU - Kontopoulou, Ntina
AU - Paraforou,
AU - Niki
AU - Antoniadou, Eleni
AU - Mouloudi, Helen
AU - Gkeka, Eleni and
AU - Grosomanidis, Vasilis
AU - Giamarellos-Bourboulis, Evangelos J. and
AU - Kotzampassi, Katerina
JO - International Journal of Antimicrobial Agents
PY - 2022
VL - 59
TODO - 1
SP - null
PB - Elsevier
SN - 0924-8579
TODO - 10.1016/j.ijantimicag.2021.106471
TODO - Probiotics; Mechanical ventilation; Pneumonia; Sepsis; Safety;
Oropharynx
TODO - 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.
ER -