King's College, London, UK.
Am J Clin Nutr. 2010 Mar;91(3):687-703. doi: 10.3945/ajcn.2009.28759. Epub 2010 Jan 20.
Probiotics are increasingly used in patients receiving nutritional support; however, some case reports and trials have questioned their safety in such patients.
The objective was to investigate the safety of probiotics in patients receiving nutritional support through a systematic review of case reports, randomized controlled trials (RCTs), and nonrandomized trials.
The systematic review followed Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Six electronic databases were searched, a hand search of conference proceedings and reference lists was performed, and experts were contacted. Case reports, RCTs, and nonrandomized trials of probiotic use in patients also receiving enteral or parenteral nutrition were included in the review. Two reviewers independently screened the relevant articles and extracted the data.
In total, 1966 articles were identified, of which 72 fulfilled the inclusion criteria. There were 20 case reports of adverse events in 32 patients, all of which were infections due to Lactobacillus rhamnosus GG or Saccharomyces boulardii; the risk factors included central venous catheters and disorders associated with increased bacterial translocation. There were 52 articles reporting 53 trials in which 4131 patients received probiotics. Most trials showed either no effect or a positive effect on outcomes related to safety (eg, mortality and infections). Only 3 trials showed increased complications, which were largely noninfectious in nature and in specific patient groups (eg, transplant and pancreatitis). In 2 of these trials, the probiotic was administered through a postpyloric tube.
Many probiotics have been used safely in patients receiving nutritional support, although some probiotic products (strains or combinations) have been shown to increase the risk of complications in specific patient groups.
益生菌越来越多地用于接受营养支持的患者；然而，一些病例报告和试验对其在这些患者中的安全性提出了质疑。
通过系统评价病例报告、随机对照试验（RCT）和非随机试验，调查营养支持患者中益生菌的安全性。
系统评价遵循 Cochrane 和 PRISMA（系统评价和荟萃分析的首选报告项目）建议。检索了 6 个电子数据库，进行了会议记录和参考文献的手工搜索，并联系了专家。本综述纳入了在接受肠内或肠外营养的同时使用益生菌的病例报告、RCT 和非随机试验。两名评审员独立筛选相关文章并提取数据。
共确定了 1966 篇文章，其中 72 篇符合纳入标准。有 32 例患者发生了 20 例不良事件的病例报告，均为因鼠李糖乳杆菌 GG 或布拉氏酵母菌引起的感染；危险因素包括中心静脉导管和与细菌易位增加相关的疾病。有 52 篇文章报道了 53 项试验，其中 4131 例患者接受了益生菌治疗。大多数试验表明，安全性相关结局（如死亡率和感染）没有影响或有积极影响。只有 3 项试验显示并发症增加，这些并发症主要是非感染性的，并且存在于特定的患者群体（如移植和胰腺炎）中。在其中 2 项试验中，益生菌通过幽门后管给予。
许多益生菌在接受营养支持的患者中安全使用，尽管一些益生菌产品（菌株或组合）已被证明会增加特定患者群体并发症的风险。
