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
Review
. 2020 Oct 15:8:81.
doi: 10.1186/s40560-020-00487-8. eCollection 2020.

Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

Priyam Batra  1 , Kapil Dev Soni  2 , Purva Mathur  3
Affiliations
Review

Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

Priyam Batra et al. J Intensive Care. .

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality.

Methodology: Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020).

Results: Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I 2 = 37%), duration of mechanical ventilation (mean difference -3.75, CI -6.93, -0.58; P 0.02; I 2 = 96%), length of ICU stay (mean difference -4.20, CI -6.73, -1.66; P = 0.001; I 2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I 2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD -1.94, CI -7.17, 3.28; P = 0.47; I 2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I 2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I 2 = 38%).

Discussion: Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

Keywords: Critical care; Meta-analysis; Placebo; Probiotics; Ventilator-associated pneumonia.

PubMed Disclaimer

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
Fig. 2
Fig. 2
Judgements about each risk of bias item presented as percentages across all included studies
Fig. 3
Fig. 3
Risk of bias summary: review authors’ judgments about each risk of bias item for each included study
Fig. 4
Fig. 4
A forest plot of incidence of ventilator-associated pneumonia (VAP)
Fig. 5
Fig. 5
A forest plot of duration of mechanical ventilation
Fig. 6
Fig. 6
A forest plot of length of ICU stay
Fig. 7
Fig. 7
A forest plot of length of hospital stay
Fig. 8
Fig. 8
A forest plot of incidence of oro-pharyngeal colonization
Fig. 9
Fig. 9
A forest plot of the incidence of diarrhea
Fig. 10
Fig. 10
A forest plot of in-hospital mortality
Fig. 11
Fig. 11
Forest plot of subgroup analysis (high vs the low risk of bias trials)
Fig. 12
Fig. 12
Forest plot of subgroup analysis (mixed population vs trauma population)
Fig. 13
Fig. 13
Forest plot of subgroup analysis (microorganisms vs no microorganisms reported)
Fig. 14
Fig. 14
Funnel plot of incidence of VAP
See this image and copyright information in PMC

References

    1. Timsit J-F, Esaied W, Neuville M, Bouadma L, Mourvillier B. Update on ventilator-associated pneumonia. F1000Research. 2017;6 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710313/. Cited 2020 Feb 17. - PMC - PubMed
    1. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009. - PubMed - NCBI [Internet]. [cited 2020 Feb 17]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21908073/. - PubMed
    1. Warren DK, Shukla SJ, Olsen MA, Kollef MH, Hollenbeak CS, Cox MJ, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med. 2003;31(5):1312–1317. doi: 10.1097/01.CCM.0000063087.93157.06. - DOI - PubMed
    1. Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospitalacquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT) Eur Respir J. 2017;50(3):1700582. doi: 10.1183/13993003.00582-2017. - DOI - PubMed
    1. Chen C, Wang J, Yin M, Zhao Q. Probiotics are effective in decreasing the incidence of ventilator-associated pneumonia in adult patients: a meta-analysis of randomized controlled trials. :9.

LinkOut - more resources