Effect of a Probiotic Preparation on Ventilator‐Associated Pneumonia in Critically Ill Patients Admitted to the Intensive Care Unit: A Prospective Double‐Blind Randomized Controlled Trial

Background Ventilator‐associated pneumonia (VAP) occurs as a life‐threatening complication in critically ill mechanically ventilated patients. Probiotic administration may modify the gut microbiota; however, whether this modification could decrease VAP occurrence is not known. Methods In this study, 100 adult critically ill patients undergoing mechanical ventilation for >48 hours were randomly assigned to either the probiotic or the control group. The patients in the probiotic group received 2 capsules of probiotic preparation containing Lactobacillus, Bifidobacterium, and Streptococcus spp., and those in the control group received placebo daily for 14 days. Results The patients in the probiotic group had a lower incidence of statistically microbiologically confirmed VAP. The duration of intensive care unit (ICU) and hospital stay was also lower in the probiotic group (P < .05). More than half of the patients in the control group had gastric residuals during ICU stay, compared with only 30% of patients in the probiotic group (P = .004). Probiotic usage led to a nonsignificant decrease in diarrhea, gastric and oropharyngeal colonization, and incidence of multidrug‐resistant pathogens. The Kaplan‐Meier survival curves for time to the first episode of VAP did not show a significant difference between probiotic and control groups (log‐rank test = 1.89; P = .17). Conclusions The results of probiotic administration for the prevention of VAP remain inconclusive in this trial. However, such an approach can decrease the length of ICU and hospital stay. Well‐designed multicenter clinical studies with defined combinations of probiotics and definite end points are necessary in this field.