Probiotics for the prevention of nosocomial pneumonia: Current evidence and opinions

Current Opinion in Pulmonary Medicine

Volumn 14, Issue 3, 2008, Pages 168-175

  McNabb, Brian ^a   Isakow, Warren ^a,b  

^a WASHINGTON UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b Campus Box 8052 ^*  (United States)

Author keywords

Hospital associated pneumonia; Probiotics; Synbiotics; Ventilator associated pneumonia

Indexed keywords

ANTIBIOTIC AGENT; CILASTATIN; FRUCTOSE OLIGOSACCHARIDE; IMIPENEM; PREBIOTIC AGENT; PROBIOTIC AGENT; SYNBIOTIC AGENT;

ABDOMINAL SURGERY; ACINETOBACTER; CRITICALLY ILL PATIENT; DIARRHEA; ENTEROBACTER; ENTEROCOCCUS; HOST; HUMAN; KLEBSIELLA; MICROBIAL COLONIZATION; NONHUMAN; NOSOCOMIAL PNEUMONIA; PNEUMONIA; PSEUDOMONAS AERUGINOSA; REVIEW; STAPHYLOCOCCUS AUREUS; VENTILATOR ASSOCIATED PNEUMONIA;

CRITICAL ILLNESS; CROSS INFECTION; HUMANS; PNEUMONIA; PROBIOTICS; TREATMENT OUTCOME;

EID: 42449128850     PISSN: 10705287     EISSN: 15316971     Source Type: Journal    
DOI: 10.1097/MCP.0b013e3282f76443     Document Type: Review

References (80)

1. American Thoracic Society: Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171:388-416.
2. Kollef MH. Epidemiology and risk factors for nosocomial pneumonia. Emphasis on prevention. Clin Chest Med 1999; 20:653-670.
3. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165:867-903.
4. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470-485.
5. Johanson WG, Pierce AK, Sanford JP. Changing pharyngeal bacterial flora of hospitalized patients. Emergence of Gram-negative bacilli. N Engl J Med 1969; 281:1137-1140.
6. Johanson WG, Pierce AK, Sanford JP, et al. Nosocomial respiratory infections with Gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 1972; 77:701-706.
7. Bonten MJ, Gaillard CA, de Leeuw PW, et al. Role of colonization of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia. Clin Infect Dis 1997; 24:309-319.
8. Elpern EH, Jacobs ER, Bone RC. Incidence of aspiration in tracheally intubated patients. Heart Lung 1987; 16:527-531.
9. Heyland D, Mandell LA. Gastric colonization by gram-negative bacilli and nosocomial pneumonia in the intensive care unit patient. Evidence for causation. Chest 1992; 101:187-193.
10. Torres A, Serra-Battles J, Ros E, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med 1992; 116:540-543.
11. Pingleton SK, Hinthorn DR, Liu C. Enteral nutrition in patients receiving mechanical ventilation: multiple sources of tracheal colonization include the stomach. Am J Med 1986; 80:1856-1862.
12. DuMoulin GC, Paterson DG, Hedley-White J, et al. Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet 1982; 1:242-245.
13. Elatrous S, Boujdaria R, Merghili S. Incidence and risk factors of ventilator-associated pneumonia: a one-year prospective study. Clin Intensive Care 1996; 7:276-281.
14. Beck-Sague CM, Sinkowitz RL, Chinn RY, et al. Risk factors for ventilator-associated pneumonia in surgical intensive care unit patients. Infect Control Hosp Epidemiol 1994; 17:374-376.
15. Craven DE, Kunches LM, Kilinsky V, et al. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986; 133:792-796.
16. Rello J, Sonora R, Jubert P, et al. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med 1996; 154:111-115.
17. Kollef MH, von Harz B, Prentice D, et al. Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest 1997; 112:765-773.
18. Huxley EJ, Viroslav J, Gray WR, et al. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978; 64:564-568.
19. Gluck U, Gebbers JO. Ingested probiotics reduce nasal colonization with pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and B-hemolytic streptococci). Am J Clin Nutr 2003; 77:517-520.
20. Alvarez S, Herrero C, Bru E, et al. Effect of Lactobacillus casei and yogurt administration on prevention of Pseudomonas aeruginosa infection in young mice. J Food Prot 2001; 64:1768-1774.
21. Schrezenmeir J, de Vrese M. Probiotics, prebiotics and synbiotics - approaching a definition. Am J Clin Nutr 2001; 73:361(S)-364(S).
22. Macpherson AJ, Uhr T. Induction of protective IgA by intestinal dendritic cells carrying commensal bacteria. Science 2004; 303:662-665.
23. Isolauri E, Sutas Y, Kankaanpaa P, et al. Probiotics: effects on immunity. Am J Clin Nutr 2001; 73:444S-450S.
24. Smits HH, van Beelene AJ, Hessle C, et al. Commensal Gram-negative bacteria prime human dendritic cells for enhanced IL-23 and IL-27 expression and enhanced Th1 development. Eur J Immunol 2004; 34:1371-1380.
25. Bernet MF, Brassart D, Neeser JR, et al. Lactobacillus acidophilus LA 1 binds to cultured human intestinal cell lines and inhibits cell attachment and cell invasion by enterovirulent bacteria. Gut 1994; 35:483-489.
26. Christensen HR, Frokiaer H, Pestka JJ. Lactobacilli differentially modulate expression of cytokines and maturation surface markers in murine dendritic cells. J Immunol 2002; 168:171-178.
27. Yolken RH, Ojeh C, Khatri IA, et al. Intestinal mucins inhibit rotavirus replication in an oligosaccharide-dependant manner. J Infect Dis 1994; 169:1002-1006.
28. Sutas Y, Soppi E, Kornonen H, et al. Suppression of lymphocyte proliferation in vitro by bovine caseins hydrolysed with Lactobacillus GG-derived enzymes. J Allergy Clin Immunol 1996; 98:216-224.
29. Rachmilewitz D, Katakura K, Karmeli F, et al. Toll-like receptor 9 signalling mediates the anti-inflammatory effects of probiotics in murine experimental colitis. Gastroenterology 2004; 126:520-528.
30. McCarthy J, O'Mahony L, O'Callaghan L, et al. Double blind, placebo controlled trial of two probiotic strains in interleukin 10 knockout mice and mechanistic link with cytokine balance. Gut 2003; 52:975-980.
31. Karlsson H, Larsson P, Wold AE, Rudin A. Pattern of cytokine responses to gram-positive and gram-negative commensal bacteria is profoundly changed when monocytes differentiate into dendritic cells. Infect Immun 2004; 72:2671-2678.
32. Canani RB, Cirillo P, Terrin G, et al. Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. BMJ 2007; 335:340-345.
33. Villarruel G, Rubio DM, Lopez F, et al. Saccharomyces boulardii in acute childhood diarrhoea: a randomized, placebo-controlled study. Acta Paediatr 2007; 96:538-541.
34. Szymański H, Pejcz J, Jawień M, et al. Treatment of acute infectious diarrhoea in infants and children with a mixture of three Lactobacillus rhamnosus strains - a randomized, double-blind, placebo-controlled trial. Aliment Pharmacol Ther 2006; 23:247-253.
35. Sarker SA, Sultana S, Fuchs GJ, et al. Lactobacillus paracasei strain ST11 has no effect on rotavirus but ameliorates the outcome of nonrotavirus diarrhea in children from Bangladesh. Pediatrics 2005; 116:221-228.
36. Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus sp. strain GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr 2000; 30:54-60.
37. Guarino A, Canani RB, Spagnuolo MI, et al. Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea. J Pediatr Gastroenterol Nutr 1997; 25:516-519.
38. Majamaa A, Isolauri E, Saxelin M, et al. Lactic acid bacteria in the treatment of acute rotavirus gastroenteritis. J Pediatr Gastroenterol Nutr 1995; 20:333-338.
39. Shornikova AV, Casas IA, Isolauri E, et al. Lactobacillus reuteri as a therapeutic agent in acute diarrhea in young children. J Pediatr Gastroenterol Nutr 1997; 24:399-404.
40. Salazar-Lindo E, Miranda-Langsschwager P, Campos-Sanchez M, et al. Lactobacillus casei strain GG in the treatment of infants with acute watery diarrhea: a randomized, double blind, placebo controlled clinical trial. BMC Pediatr 2004; 4:18.
41. Allen SJ, Okoko B, Martinez E, et al. Probiotics for treating infectious diarrhea. Cochrane Database Syst Rev 2004; 2:CD003048.
42. Hickson M, D'Souza AL, Muthu N, et al. Use of probiotic Lactobacillus preparation to prevent diarrhea associated with antibiotics: a randomized double blind placebo controlled trial. BMJ 2007; 335:80-85.
43. McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol 2006; 101:812-822.
44. Mcfarland LV, Surawicz CM, Greenberg RN, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 1994; 271:1913-1918.
45. Surawicz CM, Mcfarland LV, Greenberg RN, et al. The search for a better treatment for recurrent Clostridium difficle disease: use of high dose vancomycin combined with Saccharomyces boulardii. Clin Infect Dis 2000; 31:1012-1017.
46. Pochapin M. The effect of probiotics on Clostridium difficile diarrhea. Am J Gastroenterol 2000; 95:S11-S13.
47. Wullt M, Hagslatt MJ, Odenholt I. Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile-associated diarrhea: a double blind, placebo controlled trial. Scand J Infect Dis 2003; 35:365-367.
48. Lawrence SJ, Korzenik JR, Mundy LM. Probiotics for recurrent Clostridium difficile disease. J Med Microbiol 2005; 54:905-906.
49. Plummer S, Weaver MA, Harris JC, et al. Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of C. difficile diarrhea. Int Microbiol 2004; 7:59-62.
50. Kalliomaki M, Salminen S, Arvilommi H, et al. Probiotics in primary prevention of atopic disease: a randomized placebo controlled trial. Lancet 2001; 357:1076-1079.
51. Kalliomaki M, Salminen S, Poussa T, et al. Probiotics and prevention of atopic disease, 4-year follow-up of a randomized placebo controlled-trial. Lancet 2003; 361:1869-1871.
52. Viljanen M, Savilahti E, Haahtela T, et al. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy 2005; 60:494-500.
53. Weston S, Halbert A, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomized controlled trial. Arch Dis Child 2005; 90:892-897.
54. Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. J Allergy Clin Immunol 2007; 119:184-191.
55. Fölster-Holst R, Müller F, Schnopp N, et al. Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis. Br J Dermatol 2006; 155:1256-1261.
56. Zocco MA, dal Verme LZ, Cremonini F, et al. Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 2006; 23:1567-1574.
57. Venturi A, Gionchetti P, Rizzello F, et al. Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Aliment Pharmacol Ther 1999; 13:1103-1108.
58. Bibiloni R, Fedorak RN, Tannock GW, et al. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol 2005; 100:1539-1546.
59. Tursi A, Brandimarte G, Giorgetti GM, et al. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis. Med Sci Monit 2004; 10:126-131.
60. Jain PK, McNaught CE, Anderson AD, et al. Influence of synbiotic containing Lactobacillus acidophilus La5, Bifidobacterium lactis Bb 12, Streptococcus thermophilus. Lactobacillus bulgaricus and oligofructose on gut barrier function and sepsis in critically ill patients: a randomised controlled trial. Clin Nutr 2004; 23:467-475.
61. Klarin B, Johansson ML, Molin G, et al. Adhesion of the probiotic bacterium Lactobacillus plantarum 299v onto gut mucosa in critically ill patients: a randomized open trial. Crit Care 2005; 9:R285-R293.
62. McNaught CE, Woodcock NP, Anderson AD, MacFie J. A prospective randomized trial of probiotics in critically ill patients. Clin Nutr 2005; 24:211-219.
63. Alberda C, Gramlich L, Meddings J, et al. Effects of probiotic therapy in critically ill patients: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2007; 85:816-823. Small trial (n = 28) with good study design that showed increases in IgG and IgA in favor of synbiotics. This supports possible immunomodulatory effects of synbiotics despite not showing any benefit in clinical outcomes.
64. Spindler-Vesel A, Bengmark S, Vovk I, et al. Synbiotics, prebiotics, glutamine, or peptide in early enteral nutrition: a randomized study in trauma patients. J Parenter Enteral Nutr 2007; 31:119-126.
65. Oláh A, Belágyi T, Issekutz A, et al. Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis. Br J Surg 2002; 89:1103-1107.
66. Oláh A, Belágyi T, Pótó L, et al. Synbiotic control of inflammation and infection in severe acute pancreatitis: a prospective, randomized, double blind study. Hepatogastroenterology 2007; 54:590-594. Relatively large trial (n = 83) with a decent study design that showed benefit in favor of synbiotics for a few of the many clinical outcomes discussed.
67. Kanazawa H, Nagino M, Kamiya S, et al. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg 2005; 390:104-113.
68. Rayes N, Hansen S, Seehofer D, et al. Early enteral supply of fiber and Lactobacilli versus conventional nutrition: a controlled trial in patients with major abdominal surgery. Nutrition 2002; 18:609-615.
69. Rayes N, Seehofer D, Theruvath T, et al. Supply of pre and probiotics reduces bacterial infections rates after liver transplantation-a randomized, double-blind trial. Am J Transplant 2005; 5:125-130.
70. Sugawara G, Nagino M, Nishio H, et al. Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg 2006; 244:706-714.
71. Reddy BS, Macfie J, Gatt M, et al. Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg 2007; 94:546-554.
72. Husni RN, Gordon SM, Washington JA, Longworth DL. Lactobacillus bacteremia and endocarditis. Review of 45 cases. Clin Infect Dis 1997; 25:1048-1055.
73. Rautio M, Jousimies-Somer H, Kauma H, et al. Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG. Clin Infect Dis 1999; 28:1159-1160.
74. Land MH, Rouster-Stevens K, Woods CR, et al. Lactobacillus sepsis associated with probiotic therapy. Pediatrics 2005; 115:178-181.
75. Kunz AN, Noel JM, Fairchok MD. Two cases of Lactobacillus bacteremia during probiotic treatment of short gut syndrome. J Pediatr Gastroenterol Nutr 2004; 38:457-458.
76. Salminen MK, Rautelin H, Tynkkynen S, et al. Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG. Clin Infect Dis 2004; 38:62-69.
77. Jones SD, Fullerton DA, Zamora MR, et al. Transmission of Lactobacillus pneumonia by a transplanted lung. Ann Thorac Surg 1994; 58:887-889.
78. Patel R, Cockerill FR, Parayko MK, et al. Lactobacillemia in liver transplant patients. Clin Infect Dis 1994; 18:207-212.
79. Woods GC, Boucher BA, Croce MA, Fabian TC. Lactobacillus species as a cause of ventilator-associated pneumonia in a critically ill trauma patient. Pharmacotherapy 2002; 22:1180-1182.
80. Salminen MK, Tynkkynen S, Rautelin H, et al. The efficacy and safety of probiotic Lactobacillus rhamnosus GG on prolonged, noninfectious diarrhea in HIV patients on antiretroviral therapy: a randomized, placebo-controlled, crossover trial. HIV Clin Trials 2004; 5:183-191.