Influence of synbiotic containing Lactobacillus acidophilus La5, Bifidobacterium lactis Bb 12, Streptococcus thermophilus, Lactobacillus bulgaricus and oligofructose on gut barrier function and sepsis in critically ill patients: a randomised controlled trial.
OBJECTIVE
Infective complications are a common cause of mortality and morbidity in critically ill patients. Many factors affect sepsis, one of which is gut barrier function. The aim of this study was to determine whether the oral administration of a synbiotic preparation could alter gut barrier function in critically ill patients and thus reduce sepsis.


METHODS
A total of 90 patients admitted to an intensive care unit (ICU) were randomised to receive either synbiotic or placebo preparations (45 into each group). The synbiotic preparation consisted of Lactobacillus acidophilus La5, Bifidobacterium lactis Bb 12, Streptococcus thermophilus and Lactobacillus bulgaricus (probiotics) with oligofructose (prebiotic). Gut barrier function was assessed by measurement of intestinal permeability (lactulose/rhamnose test) and culture of nasogastric aspirate on days 1 and 8. All septic complications and mortality were recorded.


RESULTS
There were no differences between the groups in terms of age, sex, APACHE II or POSSUM scores. After 1 week of therapy, patients in the synbiotic group had a significantly lower incidence of potentially pathogenic bacteria (43% versus 75%, P = 0.05) and multiple organisms (39% versus 75%, P = 0.01) in their nasogastric aspirates than controls. There were no significant differences between the groups in terms of intestinal permeability, septic complications or mortality.


CONCLUSIONS
The administration of synbiotic in critically ill patients favourably altered the microbial composition of the upper gastrointestinal tract but had no effect on intestinal permeability and was not associated with measurable clinical benefit.
Combined Gastroenterology Unit, Department of Surgery, Scarborough General Hospital, Woodlands Drive, Scarborough YO12 6QL, UK.
Prashant K
PK
Jain
Clare E
CE
McNaught
Alexander D G
AD
Anderson
John
J
MacFie
Charles J
CJ
Mitchell
D000368:Aged; D000369:Aged, 80 and over; D018988:Bacterial Translocation; D001644:Bifidobacterium / Q000502:physiology; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000382:microbiology*; D007778:Lactobacillus / Q000502:physiology; D007779:Lactobacillus acidophilus / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009844:Oligosaccharides / Q000378:metabolism*; D010539:Permeability; D019936:Probiotics / Q000008:administration & dosage / Q000627:therapeutic use*; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D048249:Streptococcus thermophilus / Q000502:physiology
D009844:Oligosaccharides; C120489:oligofructose