Probiotic Bacterial Application in Pediatric Critical Illness as Coadjuvants of Therapy.

Christian Zanza,Michele Fidel Tassi,Alessio Migneco,Andrea Piccioni,Fabio Piccolella,Veronica Ojetti,Angela Saviano,Fabrizio Racca,Yaroslava Longhitano,Tatsiana Romenskaya,Ludovico Abenavoli,Dana Shiffer,Francesca Rubulotta,Francesco Franceschi

doi:10.3390/medicina57080781

Abstract

The use of probiotics in critically ill adult and children patients has been growing exponentially over the last 20 years. Numerous factors in pediatriac intensive care unit (PICU) patients may contribute to intestinal dysbiosis, which subsequently promotes the pathobiota’s growth. Currently, lactobacillus and bifidobacterium species are mainly used to prevent the development of systemic diseases due to the subverted microbiome, followed by streptococcus, enterococcus, propionibacterium, bacillus and Escherichia coli, Lactobacillus rhamnosus GG, and Lactobacillus reuteri DSM 17938. The aim of this article is to review the scientific literature for further confirmation of the importance of the usage of probiotics in intensive care unit (ICU) patients, especially in the pediatric population. A progressive increase in nosocomial infections, especially nosocomial bloodstream infections, has been observed over the last 30 years. The World Health Organization (WHO) reported that the incidence of nosocomial infections in PICUs was still high and ranged between 5% and 10%. Petrof et al. was one of the first to demonstrate the efficacy of probiotics for preventing systemic diseases in ICU patients. Recently, however, the use of probiotics with different lactobacillus spp. has been shown to cause a decrease of pro-inflammatory cytokines and an increase in anti-inflammatory cytokines. In addition, in some studies, the use of probiotics, in particular the mix of Lactobacillus and Bifidobacterium reduces the incidence of ventilator-associated pneumonia (VAP) in PICU patients requiring mechanical ventilation. In abdominal infections, there is no doubt at all about the usefulness of using Lactobacillus spp probiotics, which help to treat ICU-acquired diarrhoea episodes as well as in positive blood culture for candida spp. Despite the importance of using probiotics being supported by various studies, their use is not yet part of the standard protocols to which all doctors must adhere. In the meantime, while waiting for protocols to be drawn up as soon as possible for use in PICUs, routine use could certainly stimulate the intestine’s immune defences. Though it is still too early to say, they could be considered the drugs of the future.

Highlights

Interest in the use of probiotics in critically ill patients in intensive care unit (ICU) for adults or children has been growing exponentially over the last 20 years with numerous studies each year, but the first trials on the importance of probiotics were carried out about 30 years ago [1].In 2002, for the first time, the World Health Organization (WHO) described probiotics as live micro-organisms that, when administered in the necessary quantities, help to maintain the homeostasis of the intestinal flora [2]
Research was limited to clinical trials, meta-analysis, randomized controlled trials (RCT), review, and systematic review
The result obtained plays an important role in the indications for the use of probiotics in this type of population; a statistically significant decrease in the incidence of ventilator-associated pneumonia (VAP) was observed in the probiotics group (17.1% vs. 48.6%, p < 0.001)

Summary

Introduction

Interest in the use of probiotics in critically ill patients in ICUs for adults or children has been growing exponentially over the last 20 years with numerous studies each year, but the first trials on the importance of probiotics were carried out about 30 years ago [1]. In 2002, for the first time, the World Health Organization (WHO) described probiotics as live micro-organisms that, when administered in the necessary quantities, help to maintain the homeostasis of the intestinal flora [2]. Studies conducted in the past have shown that the loss of normal intestinal flora and its replacement by the growth of pathogenic bacteria (dysbiosis) can lead to the development of critical illnesses [11]. Sepsis has an important impact on the gastrointestinal function and the associated permeability alteration can become a source of systemic infection [12]

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