title: Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial.
abstract: OBJECTIVE
  To evaluate the potential preventive effect of probiotics on ventilator-associated pneumonia (VAP).
  
  
  METHODS
  This was an open-label, randomized, controlled multicenter trial involving 235 critically ill adult patients who were expected to receive mechanical ventilation for ≥48 h. The patients were randomized to receive (1) a probiotics capsule containing live Bacillus subtilis and Enterococcus faecalis (Medilac-S) 0.5 g three times daily through a nasogastric feeding tube plus standard preventive strategies or (2) standard preventive strategies alone, for a maximum of 14 days. The development of VAP was evaluated daily, and throat swabs and gastric aspirate were cultured at baseline and once or twice weekly thereafter.
  
  
  RESULTS
  The incidence of microbiologically confirmed VAP in the probiotics group was significantly lower than that in the control patients (36.4 vs. 50.4 %, respectively; P = 0.031). The mean time to develop VAP was significantly longer in the probiotics group than in the control group (10.4 vs. 7.5 days, respectively; P = 0.022). The proportion of patients with acquisition of gastric colonization of potentially pathogenic microorganisms (PPMOs) was lower in the probiotics group (24 %) than the control group (44 %) (P = 0.004). However, the proportion of patients with eradication PPMO colonization on both sites of the oropharynx and stomach were not significantly different between the two groups. The administration of probiotics did not result in any improvement in the incidence of clinically suspected VAP, antimicrobial consumption, duration of mechanical ventilation, mortality and length of hospital stay.
  
  
  CONCLUSIONS
  Therapy with the probiotic bacteria B. Subtilis and E. faecalis are an effective and safe means for preventing VAP and the acquisition of PPMO colonization in the stomach.
authors.affiliation: Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, #324 Jingwu Road, Jinan, Shandong, People's Republic of China.
authors.forename: Juan
authors.initials: J
authors.lastname: Zeng
authors.affiliation: Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, #324 Jingwu Road, Jinan, Shandong, People's Republic of China. wcteicu@126.com.
authors.forename: Chun-Ting
authors.initials: CT
authors.lastname: Wang
authors.affiliation: Department of Intensive Care Unit, Taian Central Hospital, #29 Longtan Road, Taian, Shandong, People's Republic of China.
authors.forename: Fu-Shen
authors.initials: FS
authors.lastname: Zhang
authors.affiliation: Department of Intensive Care Unit, Taian Central Hospital, #29 Longtan Road, Taian, Shandong, People's Republic of China.
authors.forename: Feng
authors.initials: F
authors.lastname: Qi
authors.affiliation: Department of Intensive Care Unit, Zibo Central Hospital, #54 Gongqingtuan Xi Road, Zibo, Shandong, People's Republic of China.
authors.forename: Shi-Fu
authors.initials: SF
authors.lastname: Wang
authors.affiliation: Department of Intensive Care Unit, Zibo Central Hospital, #54 Gongqingtuan Xi Road, Zibo, Shandong, People's Republic of China.
authors.forename: Shuang
authors.initials: S
authors.lastname: Ma
authors.affiliation: Department of Intensive Care Unit, Liaocheng People's Hospital, #67 Dongchang Xi Road, Liaocheng, Shandong, People's Republic of China.
authors.forename: Tie-Jun
authors.initials: TJ
authors.lastname: Wu
authors.affiliation: Department of Intensive Care Unit, Liaocheng People's Hospital, #67 Dongchang Xi Road, Liaocheng, Shandong, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Tian
authors.affiliation: Department of Intensive Care Unit, Jinan Military General Hospital, #25 Shifan Road, Jinan, Shandong, People's Republic of China.
authors.forename: Zhao-Tao
authors.initials: ZT
authors.lastname: Tian
authors.affiliation: Department of Intensive Care Unit, Jinan Military General Hospital, #25 Shifan Road, Jinan, Shandong, People's Republic of China.
authors.forename: Shu-Liu
authors.initials: SL
authors.lastname: Zhang
authors.affiliation: Department of Intensive Care Unit, Qingdao Municipal Hospital, #5 Donghai Zhong Road, Qingdao, Shandong, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Qu
authors.affiliation: Department of Intensive Care Unit, Yantai Yuhuangding Hospital, Yuhuangding Dong Road 20#, Yantai, Shandong, People's Republic of China.
authors.forename: Lu-Yi
authors.initials: LY
authors.lastname: Liu
authors.affiliation: Department of Intensive Care Unit, Dalian Central Hospital, #42 Xuegong Street, Dalian, Liaoning, People's Republic of China.
authors.forename: Yuan-Zhong
authors.initials: YZ
authors.lastname: Li
authors.affiliation: Department of Intensive Care Unit, Dalian Central Hospital, #42 Xuegong Street, Dalian, Liaoning, People's Republic of China.
authors.forename: Song
authors.initials: S
authors.lastname: Cui
authors.affiliation: Department of Intensive Care Unit, Hebei People's Hospital, #348 Heping Xi Road, Shijiazhuang, Hebei, People's Republic of China.
authors.forename: He-Ling
authors.initials: HL
authors.lastname: Zhao
authors.affiliation: Department of Intensive Care Unit, Hebei People's Hospital, #348 Heping Xi Road, Shijiazhuang, Hebei, People's Republic of China.
authors.forename: Quan-Sheng
authors.initials: QS
authors.lastname: Du
authors.affiliation: Department of Intensive Care Unit, General Hospital of Shenyang Military Region, #83 Wenhua Road, Shenyang, Liaoning, People's Republic of China.
authors.forename: Zhuang
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Department of Intensive Care Unit, General Hospital of Shenyang Military Region, #83 Wenhua Road, Shenyang, Liaoning, People's Republic of China.
authors.forename: Chun-Hua
authors.initials: CH
authors.lastname: Li
authors.affiliation: Department of Intensive Care Unit, Jinan Central Hospital, #105 Jiefang Road, Jinan, Shandong, People's Republic of China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Intensive Care Unit, Jinan Central Hospital, #105 Jiefang Road, Jinan, Shandong, People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Si
authors.affiliation: Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, #324 Jingwu Road, Jinan, Shandong, People's Republic of China.
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Chu
authors.affiliation: Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, #324 Jingwu Road, Jinan, Shandong, People's Republic of China.
authors.forename: Mei
authors.initials: M
authors.lastname: Meng
authors.affiliation: Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, #324 Jingwu Road, Jinan, Shandong, People's Republic of China.
authors.forename: Hong-Sheng
authors.initials: HS
authors.lastname: Ren
authors.affiliation: Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, #324 Jingwu Road, Jinan, Shandong, People's Republic of China.
authors.forename: Ji-Cheng
authors.initials: JC
authors.lastname: Zhang
authors.affiliation: Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, #324 Jingwu Road, Jinan, Shandong, People's Republic of China.
authors.forename: Jin-Jiao
authors.initials: JJ
authors.lastname: Jiang
authors.affiliation: Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, #324 Jingwu Road, Jinan, Shandong, People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Ding
authors.affiliation: Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, #324 Jingwu Road, Jinan, Shandong, People's Republic of China.
authors.forename: Yu-Ping
authors.initials: YP
authors.lastname: Wang
mesh_terms: D000328:Adult; D001412:Bacillus subtilis; D001424:Bacterial Infections / Q000517:prevention & control*; D016638:Critical Illness; D013293:Enterococcus faecalis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000517:prevention & control*; D019936:Probiotics / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000009:adverse effects*; D013270:Stomach / Q000382:microbiology; D013272:Stomach Diseases / Q000517:prevention & control*; D013997:Time Factors; D055815:Young Adult
keywords: Gastric colonization; Prevention and control; Probiotics; Ventilator-associated pneumonia