Clinical question: Does administration of probiotic L rhamnosus GG to critically ill patients requiring mechanical ventilation decrease ventilator-associated pneumonia (VAP) events?
Background: Previous trials in critically ill patients suggest that probiotics may reduce VAP and other ICU-acquired infections and may be a cost-effective solution to prevention, but uncertainty remains.
Study design: Randomized placebo-controlled trial.
Setting: Conducted in 44 intensive care units (ICUs) in Canada, the United States, and Saudi Arabia in 2,650 patients with >72 hours of mechanical ventilation.
Synopsis: VAP developed in 21.9% versus 21.3% of intervention and placebo patients respectively (HR 1.03, 95% CI -2.5% to 3.7%, P=0.73). No difference was noted in secondary endpoints of ICU-acquired infections (including C. difficile), diarrhea, antimicrobial use, mortality, or length of stay. More adverse events were found in the probiotic group with the organism detected in sterile sites or as the predominant organism from non-sterile sites (OR 14.02, 95% CI, 1.79-109.6, P<0.001).
Bottom line: Routine use of probiotics did not decrease VAP events or other ICU-acquired infections in critically ill mechanically ventilated patients and adverse events were more common.
Citation: Johnstone, J et al. Effect of probiotics on incident ventilator-associated pneumonia in critically ill patients. JAMA. 2021; 326(11):1024-33.
Dr. Berry is an assistant professor of medicine at the University of Colorado School of Medicine hospital medicine section, Rocky Mountain Regional VA Medical Center, Aurora, Colo.