Probiotic effects in prevention from ventilator-associated pneumonia

Abstract

Introduction: Regarding the role of probiotics in the balance of aerodigestive microorganism in the digestive system and the central role of bacteria colonization in the pathogenesis of ventilator associated pneumonia (VAP), the propose of this study was to investigate the effect of probiotics in prevention from ventilation associated pneumonia in ICU patients, who were undergoing mechanical ventilation with high risk for VAP. Materials and Methods: Patients (n=60) hospitalized at ICU of Valiasr Hospital, Arak, Iran participated in a randomized, double-blind, placebo-controlled clinical trial. Patients were randomly divided into two groups (intervention and placebo). Intervention group received Lactobacillus rhamnosus Gagavage three times a day in addition to a routine care. Control group received placebo in addition to a routine care. Demographic and clinical data were recorded and clinical response to primary outcome (prevalence of VAP) and secondary (other clinical factors) was interpreted. Data were analyzed in SPSS 18, using student t-test and chi-square. Results: Twenty two patients (36.6%) were diagnosed with VAP, of which, 7 (23.3%), and 15 (50%) patients were in the probiotic and control groups, respectively. (p=0.03). The average of days spent in ICU (intervention: 14.2±4.7 vs control: 17.6±6.5, p=0.028), hospitalization (intervention: 24.1±5.6 vs control: 27.4±6.6, p=0.041), and number of patients with diarrhea caused by clostridium difficile (intervention: 1(23.3%) vs control: 6 (20%), p=0.04), were significantly lower in the probiotic group than the placebo group. The mean of intubation time till receiving VAP (intervention: 10.5±1.02 vs Control: 6.1±2.6, p=0.008) and full recovery (intervention: 25 (83.3%) vs control: 14(46.6), p=0.028) were significantly higher in the intervention than the control group. Conclusion: These findings successfully presented that probiotics could effectively protect from VAP in a selected, high-risk ICU patients. As a result, the use of this therapy, in patients undergoing long-term intubation is recommended.