Abstract
Intestinal microbiota play an important role in the pathogenesis of surgical site infections (SSIs) and other surgery-related complications (SRCs). Probiotics and synbiotics were found to lower the risk of surgical infections and other surgery-related adverse events. We systematically reviewed the approach based on the administration of probiotics and synbiotics to diminish SSIs/SRCs rates in patients undergoing various surgical treatments and to determine the mechanisms responsible for their effectiveness. A systematic literature search in PubMed/MEDLINE/Cochrane Central Register of Controlled Trials from the inception of databases to June 2018 for trials in patients undergoing surgery supplemented with pre/pro/synbiotics and randomized to the intervention versus placebo/no treatment and reporting on primarily: (i) putative mechanisms of probiotic/symbiotic action, and secondarily (ii) SSIs and SRCs outcomes. Random-effect model meta-analysis and meta-regression analysis of outcomes was done. Thirty-five trials comprising 3028 adult patients were included; interventions were probiotics (n = 16) and synbiotics (n = 19 trials). We found that C-reactive protein (CRP) and Interleukin-6 (IL-6) were significantly decreased (SMD: −0.40, 95% CI [−0.79, −0.02], p = 0.041; SMD: −0.41, 95% CI [−0.70, −0.02], p = 0.006, respectively) while concentration of acetic, butyric, and propionic acids were elevated in patients supplemented with probiotics (SMD: 1.78, 95% CI [0.80, 2.76], p = 0.0004; SMD: 0.67, 95% CI [0.37, −0.97], p = 0.00001; SMD: 0.46, 95% CI [0.18, 0.73], p = 0.001, respectively). Meta-analysis confirmed that pro- and synbiotics supplementation was associated with significant reduction in the incidence of SRCs including abdominal distention, diarrhea, pneumonia, sepsis, surgery site infection (including superficial incisional), and urinary tract infection, as well as the duration of antibiotic therapy, duration of postoperative pyrexia, time of fluid introduction, solid diet, and duration of hospital stay (p < 0.05). Probiotics and synbiotics administration counteract SSIs/SRCs via modulating gut-immune response and production of short chain fatty acids.
Highlights
One of the most challenging health care issues worldwide are surgical site infections (SSIs) [1,2]
The data are mounting that the host complex of bacteria, fungi, viruses, and Archaea contribute to human biology [76]
In patients scheduled for elective abdominal surgery, the gut microbiota might undergo alterations that have an impact on surgery outcomes
Summary
One of the most challenging health care issues worldwide are surgical site infections (SSIs) [1,2]. There is increasing evidence that human intestinal microbiota play an important role in the pathogenesis of SSIs. historically, gut flora has been considered as a pathogen in human infections [9], recent studies show that alteration of the human microbiome (dysbiosis) may play a role in the pathogenesis of SSIs and other surgery-related complications (SRCs) [10–12]. The general health status of a patient scheduled for surgery is of particular interest, and the make-up of the microbiota could be of particular interest, because it is believed that the majority of hospital infections originate from the patient’s own microbiota, in part due to noxious and stressful surgical preparatory procedures [2]. Supporting the role of microbiota, it has been shown that mechanic bowel preparation (MBP) before gut resection, accompanied by oral antibiotic therapy, reduces the number of infectious complications, including anastomotic leakages by almost half [17]. Multiple studies have reported vast disturbances in microbial counts and diversity following these procedures that may itself create microbiota disturbances with health consequences [18,19]
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