Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2011 Jan;37(1):110-7.
doi: 10.1007/s00134-010-2002-6. Epub 2010 Aug 19.

Probiotics versus antibiotic decontamination of the digestive tract: infection and mortality

Guy J Oudhuis  1 , Dennis C Bergmans, Tom Dormans, Jan-Harm Zwaveling, Alfons Kessels, Martin H Prins, Ellen E Stobberingh, Annelies Verbon
Affiliations
Comparative Study

Probiotics versus antibiotic decontamination of the digestive tract: infection and mortality

Guy J Oudhuis et al. Intensive Care Med. 2011 Jan.

Abstract

Purpose: Selective decontamination of the digestive tract (SDD) has been shown to decrease the infection rate and mortality in intensive care units (ICUs); Lactobacillus plantarum 299/299v plus fibre (LAB) has been used for infection prevention and does not harbour the potential disadvantages of antibiotics. The objective was to assess whether LAB is not inferior to SDD in infection prevention.

Methods: Two hundred fifty-four consecutive ICU patients with expected mechanical ventilation ≥ 48 h and/or expected ICU stay ≥ 72 h were assigned to receive SDD: four times daily an oral paste (polymyxin E, gentamicin, amphotericin B), enteral solution (same antibiotics), intravenous cefotaxime (first 4 days) or LAB: two times daily L. plantarum 299/299v with rose-hip.

Results: The primary endpoint was infection rate. A difference <12% between both groups indicated non-inferiority of LAB. The trial was prematurely stopped after a study reporting increased mortality in critically ill pancreatitis patients receiving probiotics. No significant difference in infection rate [31% in the LAB group, 24% in the SDD group (OR 1.68, 95% CI 0.91-3.08; p = 0.10)] was found. ICU mortality was 26% and not significantly different between the LAB and SDD groups. Gram-positive cocci and Pseudomonas aeruginosa were significantly more frequently isolated from surveillance cultures in the SDD group compared to the LAB group (for sputum: 18 vs. 10% and 33 vs. 14%). Significantly more Enterobacteriaceae were found in the LAB group (23 vs. 50%). No increase in antibiotic resistance was found during and after SDD or LAB use.

Conclusions: The trial could not demonstrate the non-inferiority of LAB compared with SDD in infection prevention. Results suggest no increased ICU mortality risk in the LAB group.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flowchart of patient enrolment. SDD selective decontamination of the digestive tract, LAB, L. plantarum 299/299v plus fibre
Fig. 2
Fig. 2
Kaplan-Meier time-to-event analysis for the incidence of infectious events. p = 0.38, by log rank test. SDD, selective decontamination of the digestive tract; LAB, L. plantarum 299/299v plus fibre
See this image and copyright information in PMC

Comment in

  • Gut overgrowth harms the critically ill.
    Petros A, Taylor N, van Saene HK, Silvestri L. Petros A, et al. Intensive Care Med. 2011 Sep;37(9):1560; author reply 1561-2. doi: 10.1007/s00134-011-2287-0. Epub 2011 Jun 28. Intensive Care Med. 2011. PMID: 21710115 No abstract available.

References

    1. Inan D, Saba R, Gunseren F, Ongut G, Turhan O, Yalcin AN, Mamikoglu L. Daily antibiotic cost of nosocomial infections in a Turkish university hospital. BMC Infect Dis. 2005;5:5. doi: 10.1186/1471-2334-5-5. - DOI - PMC - PubMed
    1. Vincent JL. Nosocomial infections in adult intensive-care units. Lancet. 2003;361:2068–2077. doi: 10.1016/S0140-6736(03)13644-6. - DOI - PubMed
    1. Park DR. The microbiology of ventilator-associated pneumonia. Respir Care. 2005;50:742–763. - PubMed
    1. Stoutenbeek CP, van Saene HK, Miranda DR, Zandstra DF. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med. 1984;10:185–192. doi: 10.1007/BF00259435. - DOI - PubMed
    1. De Jonge E, Schultz MJ, Spanjaard L, Bossuyt PM, Vroom MB, Dankert J, Kesecioglu J. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet. 2003;362:1011–1016. doi: 10.1016/S0140-6736(03)14409-1. - DOI - PubMed

Publication types

Substances