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Randomized Controlled Trial
. 2018 Sep 27;22(1):239.
doi: 10.1186/s13054-018-2167-x.

Synbiotics modulate gut microbiota and reduce enteritis and ventilator-associated pneumonia in patients with sepsis: a randomized controlled trial

Kentaro Shimizu  1 , Tomoki Yamada  2 , Hiroshi Ogura  2 , Tomoyoshi Mohri  3 , Takeyuki Kiguchi  3 , Satoshi Fujimi  3 , Takashi Asahara  4 , Tomomi Yamada  5 , Masahiro Ojima  2 , Mitsunori Ikeda  2 , Takeshi Shimazu  2
Affiliations
Randomized Controlled Trial

Synbiotics modulate gut microbiota and reduce enteritis and ventilator-associated pneumonia in patients with sepsis: a randomized controlled trial

Kentaro Shimizu et al. Crit Care. .

Abstract

Background: Commensal microbiota deteriorate in critically ill patients. The preventive effects of probiotic/synbiotic therapy on microbiota and septic complications have not been thoroughly clarified in patients with sepsis. The objective of this study was to evaluate whether synbiotics have effects on gut microbiota and reduce complications in mechanically ventilated patients with sepsis.

Methods: Sepsis patients who were mechanically ventilated in the intensive care unit (ICU) were included in this randomized controlled study. Patients receiving daily synbiotics (Bifidobacterium breve strain Yakult, Lactobacillus casei strain Shirota, and galactooligosaccharides) initiated within 3 days after admission (the Synbiotics group) were compared with patients who did not receive synbiotics (the No-Synbiotics group). The primary outcome was infectious complications including enteritis, ventilator-associated pneumonia (VAP), and bacteremia within 4 weeks from admission. The secondary outcomes included mortality within 4 weeks, fecal bacterial counts, and organic acid concentration. Enteritis was defined as the acute onset of continuous liquid stools for more than 12 h.

Results: Seventy-two patients completed this trial; 35 patients received synbiotics and 37 patients did not receive synbiotics. The incidence of enteritis was significantly lower in the Synbiotics than the No-Synbiotics group (6.3% vs. 27.0%; p < 0.05). The incidence of VAP was also significantly lower in the Synbiotics than the No-Synbiotics group (14.3% vs. 48.6%; p < 0.05). The incidence of bacteremia and mortality did not differ significantly between the two groups. In the analysis of fecal bacteria, the number of Bifidobacterium and Lactobacillus in the Synbiotics group was significantly higher than that in the No-Synbiotics group. In the analysis of fecal organic acids, total organic acid concentration, especially the amounts of acetate, were significantly greater in the Synbiotics group than in the No-Synbiotics group at the first week (p < 0.05).

Conclusions: Prophylactic synbiotics could modulate the gut microbiota and environment and may have preventive effects on the incidence of enteritis and VAP in patients with sepsis.

Trial registration: UMIN, R000007633 . Registered on 29 September 2011.

Keywords: Diarrhea; Gut; Microbiota; Probiotics; Sepsis; Short-chain fatty acids; Synbiotics; Ventilator-associated pneumonia.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review board of Osaka University. Informed consent was obtained from the family of each patient. The clinical trial registry number is UMIN R000007633.

Consent for publication

Not applicable.

Competing interests

The authors co-worked with the Yakult Central Institute to evaluate the fecal samples. The authors received no research funds from the Yakult Central Institute.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study participants and flow chart
Fig. 2
Fig. 2
The cumulative incidences of enteritis were significantly lower in the Synbiotics group than in the No-Synbiotics group by log-rank test (p < 0.05)
Fig. 3
Fig. 3
The cumulative incidences of ventilator-associated pneumonia (VAP) were significantly lower in the Synbiotics group than in the No-Synbiotics group by log-rank test (p < 0.05)
See this image and copyright information in PMC

Comment in

References

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