In the Journals

Probiotic ineffective for prevention, elimination of GI colonization with drug-resistant organisms

Administration of probiotics showed no benefit or harm for preventing or eliminating gastrointestinal colonization with multidrug-resistant organisms in ICU patients, according to results from a randomized controlled trial.

“Our research suggests that probiotics do not help prevent gastrointestinal colonization with multidrug-resistant organisms in critically ill patients,” Jennie H. Kwon, DO, from the division of infectious diseases at Washington University School of Medicine in St. Louis, said in a press release.

Aiming to determine whether Lactobacillus rhamnosus GG can safely prevent intestinal colonization with multidrug-resistant organisms in critically ill patients, Kwon and colleagues performed a prospective, randomized controlled pilot study at Barnes-Jewish Hospital from February 2012 to October 2013. They randomly assigned 103 adult ICU patients to standard of care or one probiotic capsule containing 1 x 1010 L. rhamnosus GG cells (Culturelle, i-Health) twice daily for 2 weeks or until study exit. Patients with intubation or nasogastric tube received the probiotic via a saline slurry.

The primary outcome was colonization of multidrug-resistant organisms in the GI tract, including Clostridium difficile, vancomycin-resistant enterococci and Pseudomonas aeruginosa, and secondary endpoints were safety and loss of colonization. Stool or rectal swab samples were collected at enrollment and every 3 days, and 70 patients with at least three specimens were included in the outcomes analysis.

They found no difference in acquisition of any multidrug-resistant organisms between the probiotic group (10%) and patients who received standard of care (15%). There also was no difference in loss of colonization between groups, and no probiotic-related adverse events.

The researchers acknowledged the study’s limitations include small sample size, length of follow-up, use of a single probiotic type and dose, extensive exclusion criteria and that they “did not survey for gastric or upper airway colonization, which may be an important site for [multidrug-resistant organism] colonization.”

“Further research is needed on this emerging intervention to evaluate the effectiveness in preventing intestinal colonization of drug-resistant organisms,” Kwon said in the press release. – by Adam Leitenberger

Disclosure: Kwon reports no relevant financial disclosures. Please see the study for a full list of all other researchers’ relevant financial disclosures.