Division of Pulmonary and Critical Care Medicine, Creighton University Medical Center, Omaha, NE 68131, USA.
Nutr Clin Pract. 2012 Apr;27(2):235-41. doi: 10.1177/0884533612440290.
Probiotics are living microorganisms that, when ingested in adequate amounts, provide benefits to the host. The benefits include either a shortened duration of infections or decreased susceptibility to pathogens. Proposed mechanisms of beneficial effects include improving gastrointestinal barrier function, modification of the gut flora by inducing host cell antimicrobial peptides and/or local release of probiotic antimicrobial factors, competition for epithelial adherence, and immunomodulation. With increasing intensive care unit (ICU) antibacterial resistance rates and fewer new antibiotics in the research pipeline, focus has been shifted to non-antibiotic approaches for the prevention and treatment of nosocomial infections. Probiotics offer promise to ICU patients for the prevention of antibiotic-associated diarrhea, Clostridium difficile infections, multiple organ dysfunction syndrome, and ventilator-associated pneumonia. Our current understanding of probiotics is confounded by inconsistency in probiotic strains studied, optimal dosages, study durations, and suboptimal sample sizes. Although probiotics are generally safe in the critically ill, adverse event monitoring must be rigorous in these vulnerable patients. Delineation of clinical differences of various effective probiotic strains, their mechanisms of action, and optimal dosing regimens will better establish the role of probiotics in various disorders. However, probiotic research will likely be hindered in the future given a recent ruling by the U.S. Food and Drug Administration.
益生菌是活的微生物，当以足够的量摄入时，会为宿主提供益处。这些益处包括缩短感染持续时间或降低对病原体的易感性。有益效果的拟议机制包括改善胃肠道屏障功能、通过诱导宿主细胞抗菌肽和/或局部释放益生菌抗菌因子来改变肠道菌群、与上皮细胞黏附的竞争以及免疫调节。随着重症监护病房（ICU）中抗菌药物耐药率的增加和研究管道中新型抗生素的减少，人们的注意力已转移到非抗生素方法上，以预防和治疗医院获得性感染。益生菌为 ICU 患者预防抗生素相关性腹泻、艰难梭菌感染、多器官功能障碍综合征和呼吸机相关性肺炎提供了希望。由于研究中益生菌菌株、最佳剂量、研究持续时间和样本量不足等方面的不一致性，我们目前对益生菌的理解存在混淆。尽管益生菌在危重病患者中通常是安全的，但必须对这些脆弱患者进行严格的不良事件监测。各种有效益生菌菌株的临床差异、其作用机制和最佳剂量方案的确定将更好地确定益生菌在各种疾病中的作用。然而，鉴于美国食品和药物管理局最近的一项裁决，益生菌研究可能会受到阻碍。
