title: A meta-analysis of probiotic and synbiotic use in elective surgery: does nutrition modulation of the gut microbiome improve clinical outcome?
abstract: BACKGROUND
  Perioperative nutrition modulation of gut microbiota is increasingly used as a strategy for reducing the infective complications of elective surgery. This meta-analysis assessed the effect of probiotic and synbiotic preparations on the incidence of postoperative sepsis.
  
  
  METHODS
  Randomized controlled trials that compared preoperative dosing of probiotics and synbiotics in patients undergoing elective general surgical procedures were included. The primary outcome measure was the postoperative sepsis rate. Pooled outcome measures were determined using random effects models.
  
  
  RESULTS
  Thirteen randomized controlled trials totaling 962 patients were included in this analysis (304 received synbiotics and 182 received probiotics). The incidence of postoperative sepsis was reduced in the probiotic group vs the control (pooled odds ratio [OR] = 0.42; 95% confidence interval [CI], 0.23-0.75; P = .003) and in the synbiotic group vs the control (pooled OR = 0.25; 95% CI, 0.1-0.6; P = .002). However, subgroup analysis failed to identify a significant reduction in the incidence of pneumonia, urinary tract infections, or wound infections in the postoperative phase for either treatment group. Synbiotics reduced the length of postoperative antibiotic use (weighted mean differences = -1.71; 95% CI, -3.2 to -0.21; P = .03).
  
  
  CONCLUSIONS
  Probiotic and synbiotic nutrition strategies reduce the incidence of postoperative sepsis in the elective general surgery setting. These effects appear more pronounced with the use of synbiotics. High-powered, mechanistic studies are now required for the optimization of pro- and prebiotic regimens to further improve their efficacy.
authors: Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, UK.
authors: James Macalister
authors: JM
authors: Kinross
authors: Sheraz
authors: S
authors: Markar
authors: Alan
authors: A
authors: Karthikesalingam
authors: Andre
authors: A
authors: Chow
authors: Nicholas
authors: N
authors: Penney
authors: David
authors: D
authors: Silk
authors: Ara
authors: A
authors: Darzi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D054892:Metagenome; D011014:Pneumonia / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D019936:Probiotics / Q000627:therapeutic use*; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*; D058616:Synbiotics; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000517:prevention & control; D014946:Wound Infection / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents