Lacticaseibacillus rhamnosus GG Versus Placebo for Eradication of Vancomycin-Resistant Enterococcus faecium in Intestinal Carriers: A Systematic Review and Meta-Analysis

Abstract

The aim of this review was to assess the efficacy and safety of Lacticaseibacillus rhamnosus GG (LGG) (previously known as Lactobacillus rhamnosus GG) for the eradication of vancomycin-resistant Enterococcus faecium (VREfm) in colonized carriers. We searched Cochrane Central, EMBASE, and the PubMed Library from inception to 21 August 2023, for randomized controlled trials (RCTs) investigating the effectiveness of LGG for the eradication of gastrointestinal carriage of VREfm. An initial screening was performed followed by a full-text evaluation of the papers. Out of 4076 articles in the original screening, six RCTs (167 participants) were included in the review. All were placebo-controlled RCTs. The meta-analysis was inconclusive with regard to the effect of LGG for clearing VREfm colonization. The overall quality of the evidence was low due to inconsistency and the small number of patients in the trials. We found insufficient evidence to support the use of LGG for the eradication of VREfm in colonized carriers. There is a need for larger RCTs with a standardized formulation and dosage of LGG in future trials.

Keywords: LGG; VREfm; carriers; eradication; meta-analysis; systematic review.

Figure 1

Flowchart of in- and excluded papers [36].

Figure 2

The forest plot presents a meta-analysis of six studies evaluating the risk difference (RD) using the Mantel–Haenszel weighting method. The analysis reveals a high degree of heterogeneity among the studies (I² = 89.8%, p < 0.001). A total of 167 observations were included, with 74 events recorded [25,29,30,31,38,39].

Figure 3

Risk of bias assessment. Green indicates low risk of bias, red indicates high risk of bias, and black indicates unclear risk of bias or could not be assessed [25,29,30,31,38,39].