Probiotics in critically ill children.

Sunit C Singhi,Suresh Kumar

doi:10.12688/f1000research.7630.1

Abstract

Gut microflora contribute greatly to immune and nutritive functions and act as a physical barrier against pathogenic organisms across the gut mucosa. Critical illness disrupts the balance between host and gut microflora, facilitating colonization, overgrowth, and translocation of pathogens and microbial products across intestinal mucosal barrier and causing systemic inflammatory response syndrome and sepsis. Commonly used probiotics, which have been developed from organisms that form gut microbiota, singly or in combination, can restore gut microflora and offer the benefits similar to those offered by normal gut flora, namely immune enhancement, improved barrier function of the gastrointestinal tract (GIT), and prevention of bacterial translocation. Enteral supplementation of probiotic strains containing either Lactobacillus alone or in combination with Bifidobacterium reduced the incidence and severity of necrotizing enterocolitis and all-cause mortality in preterm infants. Orally administered Lactobacillus casei subspecies rhamnosus, Lactobacillus reuteri, and Lactobacillus rhamnosus were effective in the prevention of late-onset sepsis and GIT colonization by Candida in preterm very low birth weight infants. In critically ill children, probiotics are effective in the prevention and treatment of antibiotic-associated diarrhea. Oral administration of a mix of probiotics for 1 week to children on broad-spectrum antibiotics in a pediatric intensive care unit decreased GIT colonization by Candida, led to a 50% reduction in candiduria, and showed a trend toward decreased incidence of candidemia. However, routine use of probiotics cannot be supported on the basis of current scientific evidence. Safety of probiotics is also a concern; rarely, probiotics may cause bacteremia, fungemia, and sepsis in immunocompromised critically ill children. More studies are needed to answer questions on the effectiveness of a mix versus single-strain probiotics, optimum dosage regimens and duration of treatment, cost effectiveness, and risk-benefit potential for the prevention and treatment of various critical illnesses.

Highlights

Ill patients are predisposed to altered gut microflora, which can lead to infective and non-infective complications and adverse outcome[1,2,3]
We examine the current status of probiotics in the care of critically ill children on the basis of available literature and identify directions for future research
In a placebo-controlled Randomized controlled trial (RCT), we found that administration of a mix of probiotics (L. acidophilus, L. rhamnosus, B. longum, B. bifidum, S. boulardii, and S. thermophilus) for 1 week to children being treated in a pediatric ICU (PICU) with broad-spectrum antibiotics decreased the prevalence of Candida colonization of the gastrointestinal tract (GIT) by 34.5% and 37.2% on days 7 and 14, respectively, and led to an almost 50% reduction in the incidence of candiduria[37]

Summary

Introduction

Ill patients are predisposed to altered gut microflora, which can lead to infective and non-infective complications and adverse outcome[1,2,3]. Wang et al.[30], in an RCT comprising 100 critically ill full-term infants, found that administration of a probiotics mix (L. casei, L. acidophilus, Bacillus subtilis, and Enterococcus faecalis) three times daily for 8 days enhanced immune activity, decreased incidence of nosocomial pneumonia and MODS, and reduced length of hospital stay. In a placebo-controlled RCT, we found that administration of a mix of probiotics (L. acidophilus, L. rhamnosus, B. longum, B. bifidum, S. boulardii, and S. thermophilus) for 1 week to children being treated in a PICU with broad-spectrum antibiotics decreased the prevalence of Candida colonization of the GIT by 34.5% and 37.2% on days 7 and 14, respectively, and led to an almost 50% reduction in the incidence of candiduria[37]. Well-designed, large multi-center studies are needed for a better understanding of the role of probiotics in critically ill children as well as their pharmacokinetics, mechanisms of action, appropriate dose, administrative regimens, interactions, side effects, risk-benefit potential, and selection of specific probiotics (single-strain or multi-strain), dose, and duration for specific critical care conditions

Conclusions

12. Bengmark S

Findings

17. Hoyos AB