Probiotic Prophylaxis of Ventilator-associated Pneumonia A Blinded, Randomized, Controlled Trial
Probiotic Prophylaxis of Ventilator-associated Pneumonia A Blinded, Randomized, Controlled Trial
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DOI：
10.1164/rccm.200912-1853oc
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发表时间：
2010-10-15
影响因子：
24.7
通讯作者：
Casale, Thomas B.
中科院分区：
文献类型：
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作者：
Morrow, Lee E.;Kollef, Marin H.;Casale, Thomas B.
益生菌的肠内给药可以以优先有利于最低毒力菌种生长的方式改变胃肠道环境。尚不清楚是否益生菌修改的上呼吸消化道植物群可以减少医院感染。Objective. To确定是否口咽和胃给药的鼠李糖乳杆菌GG可以降低呼吸机相关性肺炎（VAP）的发病率。方法：我们进行了一项前瞻性，随机，双盲，安慰剂对照试验的146例机械通气患者在高风险的发展VAP。患者被随机分配到接受肠内益生菌（n = 68）或惰性菊粉为基础的安慰剂（n = 70），每天两次，除了常规care. Measures和主要结果：乳酸杆菌治疗的患者显着不太可能发展微生物学证实VAP与安慰剂治疗的患者相比（40.0与19.1%; P = 0.007）。虽然接受益生菌治疗的患者与安慰剂治疗的患者相比，艰难梭菌相关性腹泻明显较少（18.6 vs. 5.8%; P = 0.02），但两组之间每次腹泻的持续时间没有差异（13.2 +/- 7.4 vs. 9.8 +/- 4.9 d; P = 0.39）。接受益生菌治疗的患者因VAP（8.6 +/- 10.3 vs. 5.6 +/- 7.8 d; P = 0.05）和C.艰难梭菌相关性腹泻（2.1 ± 4.8 SD d vs.0.5 ± 2.3 d; P = 0.02）。没有发现与益生菌给药相关的不良事件。在选择的高风险ICU人群中，鼠李糖GG在预防VAP方面是安全有效的。
Rationale Enteral administration of probiotics may modify the gastrointestinal environment in a manner that preferentially favors the growth of minimally virulent species. It is unknown whether probiotic modification of the upper aerodigestive flora can reduce nosocomial infections.Objectives: To determine whether oropharyngeal and gastric administration of Lactobacillus rhamnosus GG can reduce the incidence of ventilator-associated pneumonia (VAP).Methods: We performed a prospective, randomized, double-blind, placebo-controlled trial of 146 mechanically ventilated patients at high risk of developing VAP. Patients were randomly assigned to receive enteral probiotics (n = 68) or an inert inulin-based placebo (n = 70) twice a day in addition to routine care.Measurements and Main Results: Patients treated with Lactobacillus were significantly less likely to develop microbiologically confirmed VAP compared with patients treated with-placebo (40.0 vs. 19.1%; P = 0.007). Although patients treated with probiotics had significantly less Clostridium difficile-associated diarrhea than patients treated with placebo (18.6 vs. 5.8%; P = 0.02), the duration of diarrhea per episode was not different between groups (13.2 +/- 7.4 vs. 9.8 +/- 4.9 d; P = 0.39). Patients treated with probiotics had fewer days of antibiotics prescribed for VAP (8.6 +/- 10.3 vs. 5.6 +/- 7.8 d; P = 0.05) and for C. difficile-associated diarrhea (2.1 +/- 4.8 SD d vs. 0.5 +/- 2.3 d; P = 0 02). No adverse events related to probiotic administration were identified.Conclusions: These pilot data suggest that L. rhamnosus GG is safe and efficacious in preventing VAP in a select, high-risk ICU population.