Using Probiotics in Intensive Care with Special Reference to Lactobacillus plantarum 299 and 299v
Probiotics are Live microorganisms that confer a health benefit on the host. The composition of the microflora in the gastrointestinal tract is rather constant in healthy subjects, but is easily disturbed by severe illness and the use of antibiotics. The intestinal barrier that separates the luminal contents, with a very high density of microorganisms, from an almost sterile milieu in the gut wall, is disrupted in critically illness. Probiotic bacteria have the ability to counteract those effects on the microflora and the gut wall. Lactobacillus plantarum 299 and 299v has been shown to adhere to the intestinal mucosa throughout the gastrointestinal tract in healthy volunteers. L pl 299v was given enterally to critically ill patients and it was verified from biopsies from the rectal mucosa that L pl 299v adheres and colonise also in critically ill patients on antibiotics. Clostridium difficile is a bacterium that causes diarrhoea and aggressive inflammation in colon and infections with C diff is the most common health care related disease and is almost always related to the use of antibiotics. Probiotics have been used to reduce recurrence of C diff associated disease, and none of critically ill patients given L pl 299v enterally became infected with C diff compared to 19 % in the control group. L pl 299v was also shown to improve the intestinal permeability. Ventilator Associated Pneumonia is caused by aspiration of infected secretions from the oropharynx. In intubated, mechanically ventilated critically ill patients the oropharyngeal microflora has been deranged and the risk of colonisation with enteric bacteria is high. Oral care procedures reduce the bacterial content in the oropharynx and the risk of developing VAP. L pl 299 was shown to be as effective as the standard oral care procedure using chlorhexidine, in reducing pathogenic. Susceptibility to antibiotics of probiotics is vital in case one of the seldom appearing infections should occur. Re-isolates of L pl 299v from two studies in intensive care patients on broadspectrum antibiotics were tested against 22 different antibiotics and no change of susceptibility of clinical significance was detected when compared to the original strain.
Anesthesiology and Intensive Care, antibiotic susceptibility, intestinal permeability, Lactobacillus plantarum 299, Lactobacuillus plantarum 299v, probiotics, ICU, Clostridium difficile, critical illness, chlorhexidine, CDAD, VAP
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Department of Anaesthesiology and Intensive Care, Lund