JAMA:意外!益生菌对危重病人发生呼吸机相关肺炎并没有保护作用!

2021-10-05 MedSci原创 MedSci原创

使用益生菌与安慰剂相比,在发展呼吸机相关肺炎方面没有明显差异。

近年来,对危重病期间微生物失调的兴趣越来越大,引起了人们对用益生菌改变微生物组的治疗潜力的疑问。之前在这一人群中的随机试验表明,益生菌可以减少感染,特别是呼吸机相关肺炎(VAP),尽管也有益生菌相关感染的报道。

为了评价鼠李糖乳杆菌GG对预防重症监护室(ICU)的VAP、其他感染和其他临床重要结果的影响,来自加拿大多伦多大学的专家在加拿大、美国和沙特阿拉伯的44个ICU进行随机安慰剂对照试验,招募预测需要机械通气至少72小时的成人。2013年10月至2019年3月共招募了2653名患者,结果发表在近期JAMA杂志上。

干预措施为在对所有参与者每天2次输入鼠李糖胶(1×1010菌落形成单位)(n = 1321)或安慰剂(n = 1332)。主要结果是由一式两份的中央盲审决定的VAP。次要结果是其他ICU获得性感染,包括艰难梭菌感染、腹泻、抗菌素使用、ICU和住院时间以及死亡率。

在2653名随机患者中(平均年龄,59.8岁[SD],16.5岁),2650名(99.9%)完成了试验(平均年龄,59.8岁[SD],16.5岁;1063名女性[40.1%.],平均急性生理和慢性健康评估II评分为22.0(SD,7.8),接受研究产品的时间中值为9天(IQR,5-15天)。接受益生菌的1318名患者中有289名(21.9%)发生了VAP,而1332名对照组中有284名(21.3%)。总的来说,两组发生VAP的风险没有明显差异(HR=1.03,95%CI=0.87-1.22;P=0.73,绝对差异,0.6%,95%CI,-2.5%至3.7%)。

该研究并不支持益生菌对VAP的保护作用

在20个预先指定的次要结果中,包括其他ICU获得性感染、腹泻、抗菌素使用、死亡率或住院时间都没有显示出明显的差异。接受益生菌的15名患者(1.1%)与对照组的1名(0.1%)出现了无菌部位的鼠李糖菌或非无菌部位的唯一或主要生物体的不良事件(OR=14.02;95% CI,1.79-109.58;P < .001)。

在需要机械通气的危重病人中,使用益生菌与安慰剂相比,在发展呼吸机相关肺炎方面没有明显差异。

 

参考文献:

Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients: A Randomized Clinical Trial. JAMA. 2021;326(11):1024–1033.

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    2021-10-07 老龙一点

    学习

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    2021-10-07 Boyinsh
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    2021-10-06 病毒猎手

    #益生菌#对危重病人发生#呼吸机相关肺炎#并没有保护作用!因此,不能夸大益生菌的作用!

    0

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