Probiotic Research Results

Health Benefits of Probiotics Confirmed by Research Studies!

• New Probiotic Research for Patients at Risk of VAP
• Research Indicates Benefits For Burn Patients
• Intestinal Flora May Help Women Achieve Greater Health
• Recent Study Shows Good Bacteria Helps Reduce Incidence of Colds and Cough in Young Children
• Effective For Sufferers of Chronic Fatigue Syndrome
• Good Bacteria May Be Effective in Children With Ulcerative Colitis

American Thoracic SocietyProbiotic therapy cuts risk of VAP in half for some in ICU

Daily use of probiotics reduced ventilator-associated pneumonia (VAP) in critically ill patients by almost half, according to new research from Creighton University School of Medicine in Omaha, Nebraska.

The study was published on the American Thoracic Society's Web site ahead of the print edition of the American Journal of Respiratory and Critical Care Medicine.

It is estimated that VAP complicates the care of up to 30 percent of critical care patients receiving mechanical ventilation. "Patients with VAP have increased morbidity, mortality and hospital costs as well as prolonged intensive care unit (ICU) and hospital lengths of stay, and increased costs."

"We chose to study probiotics in this context because VAP is increasingly caused by pathogens associated with antimicrobial resistance and the supply of novel antibiotics is essentially nonexistent for the foreseeable future," said Lee E. Morrow, M.D., M.Sc., associate professor of medicine at Creighton University and lead author. "The implication is that novel methods of prevention must be our priority."

Although previous studies have suggested that probiotics might be effective in reducing risk of VAP, the results have been limited by the quality of their design.

"We were unsure what to expect with this trial," said Dr. Morrow. "Ultimately our hope was that upon completion of this 'proof of concept' study we could demonstrate two critically important points in a patient group at high risk for developing VAP: One, that properly selected probiotic agents can be safely administered to critically ill patients; and, two, when administered to the proper study population these agents also have efficacy in disease prevention. We felt that rigorously establishing these suppositions as facts was essential in order to continue to study probiotic agents in the intensive care unit setting."

Dr. Morrow and colleagues included 138 critically ill patients from a single center to receive either placebo or probiotic therapy. Patients in the treatment arm received 2 x 109 colony-forming units of Lactobacillus rhamnosus twice daily—half the dose was administered as a slurry to the oropharynx and the remainder was given through nasogatsric tube. After almost 5 years, the researchers found that daily use of probiotics not only decreased VAP infections by about 50 percent compared to placebo, but also reduced the amount of antibiotics needed in comparison to placebo-treated patients. This reduction in antibiotic consumption led to significantly fewer Clostridium difficile infections in patients given probiotics. No side effects attributable to the probiotics were observed.

Meta analysis of similar studies shows an overall reduction in VAP of 39 percent with probiotics.

"Collectively, these data suggest that Lactobacillus may represent a novel, inexpensive (retail price, $2.13 per day for four tablets as administered per protocol), and non-antibiotic approach to prevention of nosocomial infections in properly selected ICU patients," said Dr. Morrow.

Because the patients were carefully selected to reduce the risk of iatrogenic infection, and over 90 percent of patients in the ICU were deemed ineligible for the study, it is important to note, Dr. Morrow cautioned, that these findings are not applicable to all ICU patients and probiotics should not be used for VAP prophylaxis beyond the population that was included in this study.

"We strongly emphasize that these data should be viewed as preliminary in nature and cannot be generalized to the general ICU population given the prolonged period of enrollment, the rigorous inclusion criteria, the large number of exclusion criteria and the small number of patients included.

Other studies have found potentially harmful effects of probiotics, underscoring the need for meticulous monitoring of patients.

"Probiotic prophylaxis of VAP using Lactobacillus rhamnosus GG appears safe and efficacious in a select population with a very high risk of VAP," concluded Dr. Morrow. "Ultimately, probiotics may fulfill a role in antimicrobial stewardship programs given the reductions in antibiotic consumption. Larger, multicenter clinical trials with more liberal inclusion criteria are needed to establish efficacy of probiotics and to allow for extrapolation to a larger at-risk population."

Cátedra de Biología, Departamento Biomédico, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina.

Bacterial colonisation and infection remain the major causes of delayed healing and graft rejection following burns. Topical treatment is necessary to reduce the incidence of burn wound infection. Silver sulphadiazine (SD-Ag) is an often used microbicidal agent. However, this treatment produces adverse reactions and side-effects. On the basis of experimental data and clinical application of lactobacilli as probiotics, we performed this exploratory study to establish the effectiveness of bacteriotherapy with topical application of the innocuous bacteria Lactobacillus plantarum cultured in De Man, Rogosa and Sharpe medium to provide an alternative method for burn treatment using SD-Ag as a reference. These innocuous bacteria would compete with other bacteria that are wound pathogens and would modify the wound environment and promote tissue repair. Eighty burned patients from the Plastic Surgery and Burns Unit were grouped into infected (delayed) second- and third-degree and non infected (early) third-degree burns and treated with L. plantarum or SD-Ag. The proportion of patients with delayed second-degree burns was 0.71 for L. plantarum and 0.73 for SD-Ag (relative rate: -2.72%) with respect to the decrease in bacterial load (<10(5) bacteria/g of tissue), promotion of granulating tissue wound bed and healing. In early third-degree burns, the values were 0.75 for L. plantarum and 0.84 for SD-Ag (relative rate: -1.07%) in preventing wound infection and promotion of granulation tissue, 0.90 in graft taking for both treatments (relative rate: 0%) and 0.75 for L. plantarum and 0.77 for SD-Ag (relative rate: -2.60%) in healing. In delayed third-degree burns, values were 0.83 for L. plantarum and 0.71 for SD-Ag (relative rate: +16.90%) with respect to the decrease in the bacterial load (<10(5) bacteria/g of tissue) and providing a granulating tissue wound bed, 0.90 in graft taking for both treatments (relative rate: 0%) and 0.75 for L. plantarum and 0.64 for SD-Ag (relative rate: + 17.19%) in healing. Although the number of patients (between 12 and 15 per group) did not enable the application of a power statistical test, these results suggest that the L. plantarum treatment should be studied in greater depth and could be used as a valid alternative for the topical treatment of burns.

Institut für Physiologie und Biochemie der Ernährung, Max Rubner Institut, Hermann-Weigman-Strasse 1, Kiel, Germany. Michael.devrese@mri.bund.de

Among the numerous positive effects of probiotic microorganisms and prebiotic carbohydrates observed in clinical studies--the majority of which, however, does not fulfil the criteria of pharmaceutical verification--some are of specific relevance to female health. The present review addresses--besides some notes concerning the potential microbiota-hormone interactions--the first line with preventive and/or therapeutic applications of probiotic bacteria in order to maintain a balanced intestinal and urogenital flora, as well as in the case of irritable bowel syndrome, constipation (idiopathic slow-transit) and urogenital tract infections. Further aspects are the promotion of bone health and osteoporosis prevention brought about by inulin, oligofructose and galactooligosaccharides. Some further conditions, namely anorexia nervosa, the premenstrual syndrome as well as prevention or alleviation of climacteric and menopausal disorders, for which the use of probiotics is rather hypothetical or is largely studied by alternative medicine practising physicians, are addressed briefly.

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