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Probiotics for Preventing and Treating Nosocomial Infections^*

Review of Current Evidence and Recommendations

^* From the Department of Internal Medicine (Drs. Isakow and Kollef), Pulmonary and Critical Care Division, Washington University St. Louis School of Medicine, St. Louis, MO; and Department of Internal Medicine (Dr. Morrow), Division of Pulmonary and Critical Care Medicine, Creighton University School of Medicine, Omaha, NE.

Correspondence to: Warren Isakow, MD, Pulmonary and Critical Care Division, Campus Box 8052, 660 South Euclid Ave, St. Louis, MO 63110; e-mail: wisakow{at}im.wustl.edu

Abstract

Objective: To review the available clinical data supporting the use of probiotics in preventing and treating serious nosocomial infections.

Data source: A Medline database from 1996 to July 2006 and references from identified articles were used to perform a literature search relating to the clinical applications of probiotics in preventing and treating Clostridium difficile-associated diarrhea (CDD) and prevention of hospital-associated pneumonia (HAP).

Conclusion: Nosocomial infections like HAP and CDD contribute significantly to health-care costs in the United States. These clinical problems are associated with prolonged hospital stays and increased mortality in critically ill patients. The emergence of multidrug-resistant pathogens in cases of HAP and the recent description of an epidemic, toxin gene-variant strain of C difficile, combined with the anticipated lack of new antimicrobial agents in the near future emphasize the need for new, innovative strategies to prevent and treat these diseases. Probiotics normally function as colonizers and contribute to the overall health of their hosts by multiple mechanisms including immune and antibacterial effects. There is no current clinical evidence to support the use of probiotics to restore the normal human flora in critically ill patients and reduce HAP rates. Probiotics can prevent episodes of antibiotic-associated diarrhea, but their utility in treating and preventing CDD requires demonstration of benefit in multicenter clinical trials, preferably sponsored by the National Institutes of Health.

Key Words: Clostridium difficile • hospital-associated pneumonia • lactobacillus, probiotics • ventilator-associated pneumonia