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Probiotics in ICU - Drvea JCCA 2019
Probiotics in ICU - Drvea JCCA 2019
Probiotics in ICU - Drvea JCCA 2019
FA D , FA C T O R F I C T I O N ?
Vera Irawany, MD
W H AT I S P R O B I O T I C ?
Endogenous Consequences of
modulators
SEPSIS dysbiosis
Bacterial translocation
Loss epithelial integrity
Modulation of SIR <<
Endogenous
modulators Muscle wasting risk >>
changes the
In this environment, probiotics remain viable normal
intestinal
and >107 CFU/mL reach the intestine, adhered microbiota
to the modified hostile intestinal mucosa of the and favours
the growth
critically ill, and interfere with the growth of
of
potential pathogens and reverse disease status pathogens
PROBIOTIC MECHANISMS OF ACTION
PREBIOTIC MECHANISMS OF ACTION
W H AT ’ S T H E E V I D E N C E ? ?
PREBIOTICS, WHICH ARE OFTEN FOUND AS
C O M P L E X C A R B O H Y D R AT E S I N F R U I T S , V E G E TA B L E S
AND GRAINS, ARE UNDIGESTED AND UNABSORBED
UNTIL REACHING THE LARGE INTESTINE WHERE
S E L E C T I V E F E R M E N TAT I O N O C C U R S . T H I S P R O M O T E S
T H E G R O W T H A N D M E TA B O L I C A C T I V I T Y O F H O S T
F L O R A , W H I C H F U R T H E R P R O M O T E S G U T- B A R R I E R
H O M E O S TA S I S
PROBIOTICS, A S P R E V I O U S LY D I S C U S S E D , M AY
I N H I B I T T H E G R O W T H O F E N T E R I C PAT H O G E N S
THROUGH COMPLETIVE EXCLUSION. THEY ALSO
I N T E R A C T W I T H R E S I D E N T M I C R O B I O TA T O M O D U L AT E
HOST IMMUNE FUNCTION
INTRODUCTION
1. Lactobacillus
2. Bifidobacterium and 1. Saccharomyces
Streptococcus
3. Lactococcus lactis 2. Boulardii
4. Select non-pathogenic strains 3. Saccharomyces
of Escherichia coli Nissle 1917 cerevisiae
and Bacillus spp., and some
Enterococcus spp.
P R O B I O T I C - C O N TA I N I N G F O O D S
COMMON PROBIOTIC SUPPLEMENTS
SEPSIS & MODS
M E C H A N I C A L LY
I N A R C T I N C R I T I C A L LY I L L ,
V E N T I L AT E D T R A U M A PAT I E N T S , A D M I N I S T R AT I O N
OF A M U LT I S T R A I N P R O B I O T I C – P R E B I O T I C
C O M M E R C I A L F O R M U L A F O R 1 5 D AY S W A S A S S O C I AT E D
W I T H A R E D U C T I O N I N I C U L E N G T H O F S TAY
A N D V E N T I L AT O R D AY S A S W E L L A S A
R E D U C T I O N I N R AT E S O F I N F E C T I O N , S I R S ,
S E V E R E S E P S I S A N D M O R TA L I T Y ( K O T Z A M PA S S I K E T A L , 2 0 0 6 )
V E N T I L AT O R A S S O C I AT E D P N E U M O N I A
O R A L A D M I N I S T R AT I O N O F P R O B I O T I C S R E S U LT S I N D E L AY E D
C O L O N I Z AT I O N O F T H E R E S P I R AT O R Y T R A C T B Y
P S E U D O M O N A S A E R U G I N O S A LEADING TO REDUCED
R AT E S O F V A P ( F O R E S T I E C E T A L , 2 0 0 8 )
USED P R O B I O T I C S T O P R E V E N T VA P C O N C L U D E D T H AT
P R O B I O T I C A D M I N I S T R AT I O N L E D T O A S I G N I F I C A N T
R E D U C T I O N I N T H E I N C I D E N C E O F VA P A N D
L E N G T H O F I C U S TAY B U T W I T H N O S I G N I F I C A N T
D I F F E R E N C E S I N E I T H E R I C U O R H O S P I TA L M O R TA L I T Y O R
I N C I D E N C E O F D I A R R H E A (SIEMPOS II ET AL,2010)
I N F E C T I O N R AT E 6 3 % V S 9 0 %
M V ( D AY S ) 1 7 V S 3 0
L O S ( D AY S ) 2 8 V S 4 1
A N T I B I O T I C – A S S O C I AT E D D I A R R H O E A ( A A D )
• INCIDENCE: 15–25%
• HIGHER RISK IN A M I N O P E N I C I L L I N S ,
C E P H A LO S P O R I N S A N D C L I N DA M YC I N USED!
S H I F T S T H E E Q U I L I B R I U M I N T H E G U T M I C R O B I O TA T O A N
I N C R E A S E I N F A C U LTAT I V E A N A E R O B E S ! D E C R E A S E I N
S H O R T C H A I N F AT T Y A C I D P R O D U C T I O N A N D A N I N C R E A S E I N
P R O T E O LY T I C A C T I V I T Y
• S. BOULARDII IS THE MOST EFFECTIVE MICRO-ORGANISM FOR
PREVENTING AAD
M C F A R L A N D LV. S Y S T E M I C R E V I E W A N D M E TA - A N A LY S I S O F S
A C C H A R O M Y C E S B O U L A R D I I I N A D U LT PAT I E N T S
THE INTESTINE.
Q A M A R A , A B O U D O L A S , W A R N Y M , M I C H E T T I P, P O T H O U L A K I S C , L A M O N T J T, E T A L . S A C C H A R O M Y C E S B O U L A R D I I S T I M U L AT E S
INTESTINAL IMMUNOGLOBULIN A IMMUNE RESPONSE TO CLOSTRIDIUM DIFFICILE TOXIN A IN MICE. INFECT IMMUN 2001;6:2762–5
NECROTIZING ENTERO-COLITIS (NEC)
BIFIDOBACTERIUM
U S E O F M U LT I P L E S P E C I E S O F
A N D L A C T O B A C I L L U S A C I D O P H I L U S WAS
A S S O C I AT E D W I T H R E D U C E D R AT E S O F N E C A N D
D E C R E A S E D M O R TA L I T Y ( S A M A N TA M E T A L , 2 0 0 9 )
A C U T E S E V E R E PA N C R E AT I T I S
A D M I N I S T R AT I O N O F P R O B I O T I C S C A N P R E V E N T O R
R E D U C E T H E R AT E O F I N F E C T I O U S
C O M P L I C AT I O N S A N D M I N I M I S E T H E N E E D F O R
S U R G I C A L I N T E R V E N T I O N IN A C U T E
N E C R O T I Z I N G PA N C R E AT I T I S ( W U X G E T A L , 2 0 0 9 )
T H E L A R G E , M U LT I C E N T R E , D O U B L E - B L I N D E D ,
C O N T R O L L E D P R O PAT R I A S T U D Y T H AT I N C L U D E D 2 9 6
PAT I E N T S W I T H P R E S U M E D S E V E R E PA N C R E AT I T I S Y I E L D E D
A HIGHER INCIDENCE OF MESENTERIC ISCHAEMIA AND
M O R TA L I T Y F O R T H E G R O U P T H AT W A S G I V E N A
M U LT I S P E C I E S P R O B I O T I C P R E PA R AT I O N ( B A S S E L I N K M G E T A L , 2 0 0 9 )
CONCLUSION