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Open Access 01-01-2011 | Original

Probiotics versus antibiotic decontamination of the digestive tract: infection and mortality

Authors: Guy J. Oudhuis, Dennis C. Bergmans, Tom Dormans, Jan-Harm Zwaveling, Alfons Kessels, Martin H. Prins, Ellen E. Stobberingh, Annelies Verbon

Published in: Intensive Care Medicine | Issue 1/2011

Abstract

Purpose

Selective decontamination of the digestive tract (SDD) has been shown to decrease the infection rate and mortality in intensive care units (ICUs); Lactobacillus plantarum 299/299v plus fibre (LAB) has been used for infection prevention and does not harbour the potential disadvantages of antibiotics. The objective was to assess whether LAB is not inferior to SDD in infection prevention.

Methods

Two hundred fifty-four consecutive ICU patients with expected mechanical ventilation ≥48 h and/or expected ICU stay ≥72 h were assigned to receive SDD: four times daily an oral paste (polymyxin E, gentamicin, amphotericin B), enteral solution (same antibiotics), intravenous cefotaxime (first 4 days) or LAB: two times daily L. plantarum 299/299v with rose-hip.

Results

The primary endpoint was infection rate. A difference <12% between both groups indicated non-inferiority of LAB. The trial was prematurely stopped after a study reporting increased mortality in critically ill pancreatitis patients receiving probiotics. No significant difference in infection rate [31% in the LAB group, 24% in the SDD group (OR 1.68, 95% CI 0.91–3.08; p = 0.10)] was found. ICU mortality was 26% and not significantly different between the LAB and SDD groups. Gram-positive cocci and Pseudomonas aeruginosa were significantly more frequently isolated from surveillance cultures in the SDD group compared to the LAB group (for sputum: 18 vs. 10% and 33 vs. 14%). Significantly more Enterobacteriaceae were found in the LAB group (23 vs. 50%). No increase in antibiotic resistance was found during and after SDD or LAB use.

Conclusions

The trial could not demonstrate the non-inferiority of LAB compared with SDD in infection prevention. Results suggest no increased ICU mortality risk in the LAB group.

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Title: Probiotics versus antibiotic decontamination of the digestive tract: infection and mortality
Authors: Guy J. Oudhuis
Dennis C. Bergmans
Tom Dormans
Jan-Harm Zwaveling
Alfons Kessels
Martin H. Prins
Ellen E. Stobberingh
Annelies Verbon
Publication date: 01-01-2011
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 1/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-2002-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Probiotics versus antibiotic decontamination of the digestive tract: infection and mortality

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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