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Probiotics ICU

Stephen A McClave, Jayshil Patel, Neal Bhutiani
PURPOSE OF REVIEW: Maintaining gut barrier defenses, modulating immune responses, and supporting the role of commensal microbiota are major factors influencing outcome in critical illness. Of these, maintaining a commensal 'lifestyle' and preventing the emergence of a virulent pathobiome may be most important in reducing risk of infection and multiple organ failure. RECENT FINDINGS: The polymeric formulas utilized for enteral nutrition in the ICU are absorbed high in the gastrointestinal tract and may not reach the microbial burden in the cecum where their effect is most needed...
April 2018: Current Opinion in Critical Care
Hong Weng, Jian-Guo Li, Zhi Mao, Ying Feng, Chao-Yang Wang, Xue-Qun Ren, Xian-Tao Zeng
Background and Objective: Ventilator-associated pneumonia (VAP) is still an important cause of morbidity and mortality in mechanically ventilated patients. The efficacy of the probiotics for preventing VAP is still controversial. Present study was conducted to comprehensively evaluate the effect of probiotics on VAP prevention in mechanically ventilated patients. Methods: PubMed, Embase, and CENTRAL were searched up to September 2016. Eligible trials designed with randomized controlled trials (RCTs) comparing probiotics with control in mechanically ventilated patients were included...
2017: Frontiers in Pharmacology
Michael Klompas
PURPOSE OF REVIEW: To summarize and contextualize recent evidence on preventing ventilator-associated pneumonia (VAP). RECENT FINDINGS: Many centers continue to report dramatic decreases in VAP rates after implementing ventilator bundles. Interpreting these reports is complicated, however, by the subjectivity and lack of specificity of VAP definitions. More objective data suggest VAP rates may not have meaningfully changed over the past decade. If so, this compels us to re-examine and revise the prevention bundles we have been using to prevent VAP...
October 2017: Current Opinion in Critical Care
Mariangela Rondanelli, Milena Anna Faliva, Simone Perna, Attilio Giacosa, Gabriella Peroni, Anna Maria Castellazzi
The scientific literature has demonstrated that probiotics have a broad spectrum of activity, although often the results are contradictory. This study provides a critical overview of the current meta-analyses that have evaluated the efficacy of probiotics in physiologic and pathological conditions, such as metabolic disease, antibiotic-associated and Clostridium difficile-associated diarrhea, IBS, constipation, IBD, chemotherapy-associated diarrhea, respiratory tract infection, ventilator-associated pneumonia, NAFLD, liver encephalopathy, periodontitis, depression, vaginosis, urinary tract infections, pancreatitis, incidence of ventilator-associated pneumonia, hospital infection and stay in ICU, mortality of post-trauma patients, necrotising enterocolitis in premature infants...
November 2, 2017: Gut Microbes
Bastiaan W Haak, Marcel Levi, W Joost Wiersinga
PURPOSE OF REVIEW: The composition and diversity of the microbiota of the human gut, skin, and several other sites is severely deranged in critically ill patients on the ICU, and it is likely that these disruptions can negatively affect outcome. We here review new and ongoing studies that investigate the use of microbiota-targeted therapeutics in the ICU, and provide recommendations for future research. RECENT FINDINGS: Practically every intervention in the ICU as well as the physiological effects of critical illness itself can have a profound impact on the gut microbiota...
April 2017: Current Opinion in Critical Care
Monika A Krezalek, Andrew Yeh, John C Alverdy, Michael Morowitz
PURPOSE OF REVIEW: This review describes the relationship between nutritional therapies and the intestinal microbiome of critically ill patients. RECENT FINDINGS: The intestinal microbiome of the critically ill displays a near complete loss of health-promoting microbiota with overgrowth of virulent healthcare-associated pathogens. Early enteral nutrition within 24 h of admission to the ICU has been advocated in medical and surgical patients to avoid derangements of the intestinal epithelium and the microbiome associated with starvation...
March 2017: Current Opinion in Clinical Nutrition and Metabolic Care
Daniel McDonald, Gail Ackermann, Ludmila Khailova, Christine Baird, Daren Heyland, Rosemary Kozar, Margot Lemieux, Karrie Derenski, Judy King, Christine Vis-Kampen, Rob Knight, Paul E Wischmeyer
Critical illness is hypothesized to associate with loss of "health-promoting" commensal microbes and overgrowth of pathogenic bacteria (dysbiosis). This dysbiosis is believed to increase susceptibility to nosocomial infections, sepsis, and organ failure. A trial with prospective monitoring of the intensive care unit (ICU) patient microbiome using culture-independent techniques to confirm and characterize this dysbiosis is thus urgently needed. Characterizing ICU patient microbiome changes may provide first steps toward the development of diagnostic and therapeutic interventions using microbiome signatures...
July 2016: MSphere
Paul E Wischmeyer, Daniel McDonald, Rob Knight
PURPOSE OF REVIEW: Loss of 'health-promoting' microbes and overgrowth of pathogenic bacteria (dysbiosis) in ICU is believed to contribute to nosocomial infections, sepsis, and organ failure (multiple organ dysfunction syndrome). This review discusses new understanding of ICU dysbiosis, new data for probiotics and fecal transplantation in ICU, and new data characterizing the ICU microbiome. RECENT FINDINGS: ICU dysbiosis results from many factors, including ubiquitous antibiotic use and overuse...
August 2016: Current Opinion in Critical Care
Zhiping Yang, Qiong Wu, Yunfang Liu, Daiming Fan
BACKGROUND: Bacterial infection following gastrointestinal surgery remains a common morbidity. The aim of this study was to estimate the effect of the perioperative use of probiotics and synbiotics on postoperative infections. MATERIALS AND METHODS: We searched PubMed, Embase, and the Cochrane Library to identify pertinent randomized controlled trials (RCTs). The primary outcome was postoperative infection rate. The secondary outcomes were length of hospital and intensive care unit (ICU) stay, length of antibiotic therapy, and mortality...
August 2017: JPEN. Journal of Parenteral and Enteral Nutrition
Kathleen E Wheeler, Deborah J Cook, Sangeeta Mehta, Adriana Calce, Melanie Guenette, Marc M Perreault, Zoé Thiboutot, Mark Duffett, Lisa Burry
PURPOSE: The primary objective of this survey was to describe pharmacists' attitudes regarding probiotic use in the intensive care unit (ICU); secondary objectives were to evaluate pharmacists' knowledge and use of probiotics for critically ill patients. METHODS: The survey instrument was rigorously designed and pretested, then distributed in both English and French to Canadian ICU pharmacists. The online survey was open for 5 weeks, and 3 follow-up emails were sent to maximize response rates...
February 2016: Journal of Critical Care
Jennie H Kwon, Kerry M Bommarito, Kimberly A Reske, Sondra M Seiler, Tiffany Hink, Hilary M Babcock, Marin H Kollef, Victoria J Fraser, Carey-Ann D Burnham, Erik R Dubberke
This was a randomized controlled pilot study of Lactobacillus rhamnosus GG versus standard of care to prevent gastrointestinal multidrug-resistant organism colonization in intensive care unit patients. Among 70 subjects, there were no significant differences in acquisition or loss of any multidrug-resistant organisms (P>.05) and no probiotic-associated adverse events.
December 2015: Infection Control and Hospital Epidemiology
Tan N Doan, David C M Kong, Caroline Marshall, Carl M J Kirkpatrick, Emma S McBryde
The efficacy of infection control interventions against Acinetobacter baumannii remains unclear, despite such information being critical for effective prevention of the transmission of this pathogen. Mathematical modeling offers an alternative to clinical trials, which may be prohibitively expensive, unfeasible or unethical, in predicting the impact of interventions. Furthermore, it allows the ability to ask key "what if" questions to evaluate which interventions have the most impact. We constructed a transmission dynamic model to quantify the effects of interventions on reducing A...
2016: Virulence
Girish Deshpande, Shripada Rao, Sanjay Patole
Survival of extremely preterm and critically ill neonates has improved significantly over the last few decades following advances in neonatal intensive care. These include antenatal glucocorticoids, surfactant, continuous positive airway pressure support, advanced gentle modes of ventilation and inhaled nitric oxide. Probiotic supplementation is a recent significant milestone in the history of neonatal intensive care. Very few, if any, interventions match the ability of probiotics to significantly reduce the risk of death and definite necrotising enterocolitis while facilitating enteral feeds in high-risk preterm neonates...
June 2015: Australian & New Zealand Journal of Obstetrics & Gynaecology
Tarek Sawas, Shadi Al Halabi, Ruben Hernaez, William D Carey, Won Kyoo Cho
BACKGROUND & AIMS: Among patients who have received liver transplants, infections increase morbidity and mortality and prolong hospital stays. Administration of antibiotics and surgical trauma create intestinal barrier dysfunction and microbial imbalances that allow enteric bacteria to translocate to the blood. Probiotics are believed to prevent bacterial translocation by stabilizing the intestinal barrier and stimulating proliferation of the intestinal epithelium, mucus secretion, and motility...
September 2015: Clinical Gastroenterology and Hepatology
Westyn Branch-Elliman, Sharon B Wright, Michael D Howell
RATIONALE: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection with high associated cost and poor patient outcomes. Many strategies for VAP reduction have been evaluated. However, the combination of strategies with the optimal cost-benefit ratio remains unknown. OBJECTIVES: To determine the preferred VAP prevention strategy, both from the hospital and societal perspectives. METHODS: A cost-benefit decision model with a Markov model was constructed...
July 1, 2015: American Journal of Respiratory and Critical Care Medicine
Balasubramaniam Banupriya, Niranjan Biswal, Rangan Srinivasaraghavan, Parameswaran Narayanan, Jharna Mandal
PURPOSE: Ventilator associated pneumonia (VAP) is one of the most common nosocomial infections in the pediatric intensive care unit (PICU). It is associated with increased mortality and prolonged hospital stay. Several preventive strategies have been introduced to reduce VAP. One novel intervention is prophylactic administration of probiotics. Studies on the effect of probiotics on VAP in pediatric populations are lacking. METHODS: This was an open-label randomized controlled trial...
April 2015: Intensive Care Medicine
Dilek Dilli, Banu Aydin, Nurdan Dinlen Fettah, Elif Özyazıcı, Serdar Beken, Ayşegül Zenciroğlu, Nurullah Okumuş, Banu Mutlu Özyurt, Mehmet Şah İpek, Arzu Akdağ, Özden Turan, Şenol Bozdağ
OBJECTIVE: To test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. STUDY DESIGN: A prospective, randomized, controlled trial was conducted at 5 neonatal intensive care units in Turkey. VLBW infants (n = 400) were assigned to a control group and 3 study groups that were given probiotic (Bifidobacterium lactis), prebiotic (inulin), or synbiotic (Bifidobacterium lactis plus inulin) added to breastmilk or formula for a maximum of 8 weeks before discharge or death...
March 2015: Journal of Pediatrics
Arthur C W Lau, H M So, S L Tang, Alwin Yeung, S M Lam, W W Yan
Ventilator-associated pneumonia is the commonest, yet mostly preventable, infection in mechanically ventilated patients. Successful control of ventilator-associated pneumonia can save hospitalisation cost, and is possible by using a multidisciplinary clinical and administrative approach. The ventilator-associated pneumonia rate should be expressed as the number of ventilator-associated pneumonia days per 1000 ventilator days to take into account the device-utilisation duration for meaningful comparison. Various strategies address the issue, including general infection control measures, body positioning, intubation and mechanical ventilation, oral and gastro-intestinal tract, endotracheal tube, airway pressure, cuff pressure, selective digestive and/or oropharyngeal decontamination, and probiotic or early antibiotic treatment, as well as overall administration at a policy level...
February 2015: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
S Dang, L Shook, K Garlitz, M Hanna, N Desai
OBJECTIVE: To assess nutritional outcomes in preterm infants after the implementation of probiotics. STUDY DESIGN: Retrospective chart review of infants with birth weight⩽1250 grams and/or⩽28 weeks of gestational age admitted to the KCH-Neonatal Intensive Care Unit was done. Data were collected over two periods, period 1 (before probiotics) and period 2 (after probiotics) and included demographic data, daily weight gain, feeding strategies (type, amount, caloric content and frequency of feeds) and comorbidities affecting feedings (Patent ductus arteriosus, Sepsis)...
June 2015: Journal of Perinatology: Official Journal of the California Perinatal Association
Sarvin Sanaie, Mehrangiz Ebrahimi-Mameghani, Hadi Hamishehkar, Mojtaba Mojtahedzadeh, Ata Mahmoodpoor
BACKGROUND: Impairment of intestinal barrier function and increased translocation of bacteria to the systemic blood flow contribute to the emergence of sepsis. Probiotics might be of beneficial effects on critically ill-patients, modulating intestinal barrier function and reducing inflammation. The aim of this trial was to determine the effect of probiotics on inflammatory markers in critically ill-patients in Intensive Care Unit (ICU). MATERIALS AND METHODS: This trial was conducted on 40 critically ill-patients admitted to the ICU...
September 2014: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
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