A prospective randomised study of the probiotic Lactobacillus plantarum 299V on indices of gut barrier function in elective surgical patients

Abstract

Background: Bacterial translocation occurs in surgical patients and may predispose to postoperative septic morbidity. Many factors are thought to influence the prevalence of bacterial translocation, one of which is the composition of the gut microflora. The aim of this prospective and randomised study was to assess the effect of the probiotic Lactobacillus plantarum 299v on the incidence of bacterial translocation, gastric colonisation, and septic complications in elective surgical patients.

Methods: Patients undergoing elective major abdominal surgery were randomised to either a treatment or control group. The treatment group received an oral preparation containing Lactobacillus plantarum 299v (Proviva) for at least one week preoperatively and also in the postoperative period. Bacterial translocation was determined by culture of a mesenteric lymph node and serosal scraping obtained at laparotomy. Gastric colonisation was assessed by microbiological culture of nasogastric aspirates. All postoperative septic complications were recorded.

Results: A total of 129 patients completed the study (probiotic group n=64). There was no significant difference between the two groups in terms of bacterial translocation (12% v 12%; p=0.82), gastric colonisation with enteric organisms (11% v 17%; p=0.42), or septic morbidity (13% v 15%; p=0.74).

Conclusions: Administration of Lactobacillus plantarum 299v in elective surgical patients does not influence the rate of bacterial translocation, gastric colonisation, or incidence of postoperative septic morbidity.

Figure 1

Serial C reactive protein (CRP) measurements in the probiotic and control groups.

Figure 2

Gastric colonisation in the probiotic and control groups; proportion of nasogastric (NG) aspirates.