Probiotics for the Prevention of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Controlled Trials.
BACKGROUND
Ventilator-associated pneumonia (VAP) is a common and serious complication of mechanical ventilation. We conducted a meta-analysis of published randomized controlled trials to evaluate the efficacy and safety of probiotics for VAP prevention in patients who received mechanical ventilation.


METHODS
We searched a number of medical literature databases to identify randomized controlled trials that compared probiotics with controls for VAP prevention. The results were expressed as odds ratios (OR) or mean differences with accompanying 95% CIs. Study-level data were pooled by using a random-effects model. Data syntheses were accomplished by using statistical software.


RESULTS
Fourteen studies that involved 1,975 subjects met our inclusion criteria. Probiotic administration was associated with a reduction in VAP incidence among all 13 studies included in the meta-analysis (OR 0.62, 95% CI 0.45-0.85; P = .003; I2 = 43%) but not among the 6 double-blinded studies (OR 0.72, 95% CI 0.44-1.19; P = .20; I2 = 55%). We found a shorter duration of antibiotic use for VAP (mean difference -1.44, 95% CI -2.88 to -0.01; P = .048, I2 = 30%) in the probiotics group than in the control group, and the finding comes from just 2 studies. No statistically significant differences were found between the groups in terms of ICU mortality (OR 0.95, 95% CI 0.67-1.34; P = .77; I2 = 0%), ICU stay (mean difference -0.77, 95% CI -2.58 to 1.04; P = .40; I2 = 43%), duration of mechanical ventilation (mean difference -0.91, 95% CI -2.20 to 0.38; P = .17; I2 = 25%), or occurrence of diarrhea (OR 0.72, 95% CI 0.45-1.15; P = .17; I2 = 41%).


CONCLUSIONS
The meta-analysis results indicated that the administration of probiotics significantly reduced the incidence of VAP. Furthermore, our findings need to be verified in large-scale, well-designed, randomized, multi-center trials.
['Su|Minmin|M|', 'Jia|Ying|Y|', 'Li|Yan|Y|', 'Zhou|Dianyou|D|', 'Jia|Jinsheng|J|']
D000293:Adolescent D000328:Adult D005260:Female D006801:Humans D015994:Incidence D007362:Intensive Care Units D008297:Male D053717:Pneumonia, Ventilator-Associated D019936:Probiotics D016032:Randomized Controlled Trials as Topic D055815:Young Adult
probiotics prevent ventilator-associated pneumonia meta-analysis randomized controlled trial critical care