Preventive Effect of Probiotics on Ventilator-Associated Pneumonia: A Meta-analysis of 2428 Patients

Background: Researchers had contradictory conclusions about the role of probiotics in preventing ventilator-associated pneumonia (VAP), which has led to the controversial use of probiotics in mechanically ventilated patients. Objective: To explore the efficacy and safety of probiotics in preventing VAP. Methods: A literature search was conducted in 7 medical databases. Two investigators assessed literature quality independently and collected data. The primary outcome was the incidence of VAP. Secondary outcomes included 16 measures. Sensitivity analysis and subgroup and meta-regression analyses were performed to analyze the source of heterogeneity. P values <0.05 were considered statistically significant, and CIs were set at 95%. A random-effects model was set when I-2 <50%, otherwise a fixed-effects model was used. Results: A total of 20 randomized controlled studies with a total of 2428 patients were analyzed. Pooled results showed positive effects of probiotics on the reduction of VAP incidence (risk ratio [RR] = 0.672; P < 0.001; I-2 = 11.3%), length of ICU stay (WMD = -1.417; P = 0.012; I-2 = 90.7%), oropharyngeal (RR = 0.866; P = 0.031; I-2 = 12.4%) and gastric (RR = 0.645; P < 0.001; I-2 = 30.2%) colonization. Conclusions and Relevance: Probiotics can reduce the incidence of VAP and reduce oropharyngeal and gastric bacterial colonization. The results also suggest that probiotics do not cause adverse effects.

Automated summary

This study indicates that probiotics can reduce the incidence of VAP, as well as reduce bacterial colonization in the oropharynx and stomach. Additionally, the results suggest that probiotics do not have adverse effects.