Department of Emergency, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou, 313000, Zhejiang Province, China.
Department of Intensive Care Unit, Ningbo Yinzhou No. 2 Hospital, Ningbo, 315000, Zhejiang Province, China.
BMC Pulm Med. 2022 Apr 28;22(1):168. doi: 10.1186/s12890-022-01965-5.
Probiotic might have a role in the prevention of ventilator-associated pneumonia (VAP) among mechanically ventilated patients, but the efficacy and safety remained inconsistent. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of probiotic (prebiotic, synbiotic) versus placebo in preventing VAP in critically ill patients undergoing mechanical ventilation.
PubMed, Embase and the Cochrane library databases were searched to 10 October 2021 without language restriction for randomized or semi-randomized controlled trials evaluating probiotic (prebiotic, synbiotic) vs. placebo in prevention of VAP in critically ill mechanically ventilated patients. The pooled relative risk (RR) along with 95% confidence intervals (CI) were combined using a random-effects model. Furthermore, the trial sequential analysis (TSA) and subgroup analyses were performed. Statistical significance was regarded as P < 0.05.
Twenty-three trials involving 5543 patients were eligible for this meta-analysis. The combined RR of decreasing the risk of VAP by probiotic was 0.67 (0.56, 0.81) for all eligible studies, 0.69 (n = 5136; 95% CI = 0.57 to 0.84; P < 0.01) for adults studies and 0.55 (n = 407; 95%CI = 0.31 to 0.99; P = 0.046) for neonates/children studies. Additionally, the above-mentioned positive finding in 20 adults studies was verified by the results of TSA, subgroup analyses and cumulative meta-analysis. Ample evidences demonstrated a 31% decrease in RR of incidence of VAP was noted when prophylactic probiotic therapy was administrated among adult patients. Finally, there were no effects on the ICU/hospital/28-/90-day mortality, bacteremia, CRBSI, diarrhea, ICU-acquired infections, infectious complications, pneumonia, UTI and wound infection between two groups (P > 0.05 for all).
Based on the results of our study, the current evidences suggested that prophylactic administration of probiotic might be utilized as a preventive method for VAP in neonates/children and adults patients who required mechanical ventilation. However, further large, high-quality RCTs are warranted to assess the efficacy and safety of probiotic treatment in critically ill patients, especially for the neonates/children studies and the long-term consequences of this therapy.
益生菌可能在预防机械通气患者呼吸机相关性肺炎（VAP）方面发挥作用，但疗效和安全性仍不一致。本系统评价和荟萃分析的目的是评估益生菌（益生元、合生素）与安慰剂在预防机械通气危重症患者 VAP 中的疗效和安全性。
检索 PubMed、Embase 和 Cochrane 图书馆数据库，截至 2021 年 10 月 10 日，无语言限制，纳入评估益生菌（益生元、合生素）与安慰剂预防机械通气危重症患者 VAP 的随机或半随机对照试验。使用随机效应模型合并合并相对风险（RR）及 95%置信区间（CI）。此外，还进行了试验序贯分析（TSA）和亚组分析。统计显著性以 P<0.05 表示。
共有 23 项试验，涉及 5543 名患者，符合本荟萃分析的纳入标准。所有纳入研究中，益生菌降低 VAP 风险的合并 RR 为 0.67（0.56，0.81），成人研究为 0.69（n=5136；95%CI=0.57 至 0.84；P<0.01），新生儿/儿童研究为 0.55（n=407；95%CI=0.31 至 0.99；P=0.046）。此外，成人 20 项研究中的上述阳性结果通过 TSA、亚组分析和累积荟萃分析得到了验证。大量证据表明，预防性给予益生菌治疗可使成年患者 VAP 发生率的 RR 降低 31%。最后，两组间 ICU/医院/28 天/90 天死亡率、菌血症、CRBSI、腹泻、ICU 获得性感染、感染并发症、肺炎、尿路感染和伤口感染无差异（P>0.05 均）。
根据本研究结果，目前的证据表明，在需要机械通气的新生儿/儿童和成人患者中，预防性给予益生菌可能是预防 VAP 的一种方法。然而，仍需要进一步的大样本、高质量 RCT 来评估益生菌治疗危重症患者的疗效和安全性，特别是新生儿/儿童研究和该治疗方法的长期后果。
