Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis.
Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis.
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DOI：
10.1186/s13054-016-1434-y
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发表时间：
2016-08-19
期刊：
影响因子：
--
通讯作者：
Wischmeyer PE
中科院分区：
文献类型：
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作者：
Manzanares W;Lemieux M;Langlois PL;Wischmeyer PE
危重病的特征是共生菌群的丧失和潜在致病菌的过度生长，导致对医院感染的高度易感性。益生菌是一种活生生的非致病微生物，可以保护肠道屏障，抑制病原体过度生长，减少细菌易位，预防感染。这项最新的系统性综述的目的是评估益生菌和合生菌混合物对危重疾病临床结局的总体疗效。检索了1980年至2016年的计算机化数据库。随机对照试验(RCT)，评估作为单一策略或与益生菌纤维(合生元)联合使用的益生菌治疗的临床结果。主要结果是新感染的总人数；次要结果包括死亡率、ICU和住院时间(LOS)以及腹泻。亚组分析被用来阐明其他关键因素，如益生菌类型和患者死亡风险对益生菌对预后的影响。纳入2972名患者的30项试验被确定用于分析。益生菌与感染的显著减少相关(风险比0.80，95%可信区间(CI)0.68，0.95，P = 0.009；异质性I2 = 36%，P = 0.09)。此外，发现呼吸机相关肺炎(VAP)的发生率显著降低(风险比0.74，95%可信区间0.61，0。90，P = 0.002；I2 = 19(%)。未观察到对死亡率、LOS和腹泻的影响。亚组分析表明，尽管目前存在有限的合生元试验数据，但与合生元混合物相比，感染结局改善最大的是接受益生菌单独治疗的危重患者。益生菌在减少感染方面显示出希望，包括危重疾病中的VAP。目前，临床异质性和潜在的发表偏倚减少了强烈的临床推荐，并表明需要进一步的高质量临床试验来最终证明这些好处。
Critical illness is characterized by a loss of commensal flora and an overgrowth of potentially pathogenic bacteria, leading to a high susceptibility to nosocomial infections. Probiotics are living non-pathogenic microorganisms, which may protect the gut barrier, attenuate pathogen overgrowth, decrease bacterial translocation and prevent infection. The purpose of this updated systematic review is to evaluate the overall efficacy of probiotics and synbiotic mixtures on clinical outcomes in critical illness. Computerized databases from 1980 to 2016 were searched. Randomized controlled trials (RCT) evaluating clinical outcomes associated with probiotic therapy as a single strategy or in combination with prebiotic fiber (synbiotics). Overall number of new infections was the primary outcome; secondary outcomes included mortality, ICU and hospital length of stay (LOS), and diarrhea. Subgroup analyses were performed to elucidate the role of other key factors such as probiotic type and patient mortality risk on the effect of probiotics on outcomes. Thirty trials that enrolled 2972 patients were identified for analysis. Probiotics were associated with a significant reduction in infections (risk ratio 0.80, 95 % confidence interval (CI) 0.68, 0.95, P = 0.009; heterogeneity I2 = 36 %, P = 0.09). Further, a significant reduction in the incidence of ventilator-associated pneumonia (VAP) was found (risk ratio 0.74, 95 % CI 0.61, 0. 90, P = 0.002; I2 = 19 %). No effect on mortality, LOS or diarrhea was observed. Subgroup analysis indicated that the greatest improvement in the outcome of infections was in critically ill patients receiving probiotics alone versus synbiotic mixtures, although limited synbiotic trial data currently exists. Probiotics show promise in reducing infections, including VAP in critical illness. Currently, clinical heterogeneity and potential publication bias reduce strong clinical recommendations and indicate further high quality clinical trials are needed to conclusively prove these benefits.