title: Effect of Probiotics on the Incidence of Healthcare-Associated Infections in Mechanically Ventilated Neurocritical Care Patients.
abstract: BACKGROUND
  Healthcare-associated infections (HAIs) are seen in 17% of critically ill patients. Probiotics, live nonpathogenic microorganisms, may aid in reducing the incidence of infection in critically ill patients. We hypothesized that administration of probiotics would be safe and reduce the incidence of HAIs among mechanically ventilated neurocritical care patients.
  
  
  METHODS
  We assembled 2 retrospective cohorts of mechanically ventilated neurocritical care patients. In the preintervention cohort from July 1, 2011, to December 31, 2011, probiotics were not used. In the postintervention group from July 1, 2012, to December 31, 2012, 1 g of a combination of Lactobacillus acidophilus and Lactobacillus helveticus was administered twice daily to all patients who were mechanically ventilated for more than 24 hours.
  
  
  RESULTS
  There were a total of 167 patients included, 80 patients in the preintervention group and 87 patients in the postintervention group. No patients in the preintervention group received probiotics. Eighty-five (98%) patients in the postintervention group received probiotics for a median of 10 days (interquartile range, 4-20 days). There were 14 (18%) HAIs in the preintervention group and 8 (9%) HAIs in the postintervention group (P = .17). Ventilator days, lengths of stay, in-hospital mortality, and discharge disposition were similar between the pre- and postintervention groups. There were no cases of Lactobacillus bacteremia or other adverse events associated with probiotics use.
  
  
  CONCLUSIONS
  Probiotics are safe to administer in neurocritical care patients; however, this study failed to demonstrate a significant decrease in HAIs or secondary outcomes associated with probiotics.
authors.affiliation: Division of Neurocritical Care, Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kenna
authors.affiliation: Department of Pharmacy, Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: Leana
authors.initials: L
authors.lastname: Mahmoud
authors.affiliation: Department of Pharmacy, Rhode Island Hospital, Providence, Rhode Island, USA Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Zullo
authors.affiliation: Departments of Neurology and Neurosurgery, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: N Stevenson
authors.initials: NS
authors.lastname: Potter
authors.affiliation: Departments of Neurology and Neurosurgery, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Corey R
authors.initials: CR
authors.lastname: Fehnel
authors.affiliation: Departments of Neurology and Neurosurgery, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Bradford B
authors.initials: BB
authors.lastname: Thompson
authors.affiliation: Departments of Neurology and Neurosurgery, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA linda_wendell@brown.edu.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Wendell
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007779:Lactobacillus acidophilus; D052198:Lactobacillus helveticus; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D019936:Probiotics / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors
keywords: critical care; intensive care units; nutritional support; outcomes; probiotics