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. 2023 Dec 12;11(12):2970.
doi: 10.3390/microorganisms11122970.

Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study

Jung-Hwan Lee  1   2 , Jongbeom Shin  1 , Soo-Hyun Park  3 , Boram Cha  1 , Ji-Taek Hong  1 , Don-Haeng Lee  1 , Kye Sook Kwon  1
Affiliations

Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study

Jung-Hwan Lee et al. Microorganisms. .

Abstract

Older patients with multiple comorbidities often necessitate prolonged hospital stays and antibiotic treatment in the intensive care unit (ICU), leading to a rise in multidrug-resistant organisms like carbapenem-resistant Enterobacteriaceae (CRE). This study examined risk factors for carbapenem-resistant Enterobacteriaceae colonization in the ICU and assessed probiotics' preventive role. In this single-center, retrospective study, 9099 ICU patients were tested for stool CRE culture from March 2017 to April 2022. We excluded 136 patients with CRE colonization within one week post-admission and 26 who received probiotics before CRE colonization. Ultimately, 8937 CRE-negative patients were selected. Logistic analysis identified CRE colonization risk factors and evaluated probiotics' influence, including Saccharomyces boulardii or Lactobacillus rhamnosus, used by 474 patients (5.3%) in the ICU. Compared with data on initial admission, 157 patients (1.7%) had newly discovered CRE colonization before discharge. In a multivariate analysis, coronavirus disease 2019, the ICU, tube feeding, antibiotics such as aminoglycoside, extended-spectrum penicillin, stool vancomycin-resistance enterococci colonization, and chronic kidney disease were significantly associated with de novo CRE infection. However, probiotic use was negatively correlated with CRE infection. Managing risk factors and administering probiotics in the ICU may help prevent CRE colonization; large randomized prospective studies are needed.

Keywords: carbapenem-resistant Enterobacteriaceae; prevention; probiotics; risk factor.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patients’ selection.
Figure 2
Figure 2
Multivariable analysis of the risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) colonization.; *, p-value < 0.05; and ***, p-value < 0.001; red color texts indicated the significant factors positively correlated with CRE colonization; blue color texts indicated the significant factors negatively correlated with CRE colonization; red oval emphasizes probiotics as a significant negative correlated factor.
Figure 3
Figure 3
Microbiome analysis of 20 patients’ samples with CRE colonization, divided into probiotics (12 samples) and non-probiotics (8 samples) groups. (a) α-diversity (Shannon) between the probiotic and non-probiotic groups. (b) α-diversity (CHAO1) between the probiotic and non-probiotic groups. (c) β-diversity (unweighted uniFrac) between the probiotics group and non-probiotics group. (d) β-diversity (weighted uniFrac) between the probiotic and non-probiotic groups. The red color indicated a significant difference between the groups. Abbreviations: PERMANOVA, permutational multivariate analysis of variance.
Figure 4
Figure 4
Microbiome analysis for patients with CRE colonization according to probiotics administration. (a) Relative abundance of the Enterobacteriaceae family between the probiotics and non-probiotics groups. (b) Relative abundance of the Klebsiella genus between the probiotic and non-probiotic groups. The red color indicated a significant difference between the groups.
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