effects of a novel seven-species probiotic against oropharyngeal 13.8.94

Effects of a novel seven-species probiotic against oropharyngeal bacterial infestation in adult trauma Intensive Care Unit patients;

a randomized double blind clinical trialMansoor Masjedi , Pooya Vatankhah , Farid Zand , Gholamreza Dabiri , Shahin Raoofi , Majid Yazdani

Presented by : Mansoor Masjedi ; MD FCCMAssisstant professor of anesthesia & critical care consultant

Shiraz university of medical sciences , Iran Ankara , Turkey - November , 2015

Effects of a novel seven-species probiotic against oropharyngeal bacterial infestation in adult trauma Intensive Care Unit patients;

a randomized double blind clinical trial

This study was financially supported by the Vice chancellery for research affairs of

Shiraz University of Medical Sciences , Shiraz , Iran

Panel Discussion: Infection in ICU 9:00 - 10:00 am --- Critical Care Group

Coordinator: M.MasjediPanel members: H.R.Jamaati, M.Mokhtari, A.Taher,

E.Ginzburg

Epidemiologic assessment of infections in adult trauma ICU

Effects of a novel seven-species probiotic against oropharyngeal bacterial infestation in

adult trauma Intensive Care Unit patients; a randomized double blind clinical trial

1- How many species /much probiotic ? 2- Effect on oropharyngeal bacteria?

3- Are trauma patients different?

BACKGROUND AND AIM:To investigate the efficacy of a novel probiotic combination containing 7 bacterial species

against oropharyngeal bacterial infestation in adult trauma intensive care unit patients

novel seven-species probiotic Trauma ICUoropharyngeal bacterial

Effects of a novel seven-species probiotic against oropharyngeal bacterial infestation in adult trauma Intensive Care Unit patients; a randomized double blind clinical trial

• Administered probiotic :a capsule containing 1010 colony-forming units (cfu) of a 7 species probiotics in an inulin base , manufactured by a pharmaceutical Company, Tehran, Iran.

– Lactobacillus casei,– Lactobacillus rhamnosus,– Streptococcus thermophiles, – Bifidobacterium breve, – Lactobacillus acidophilus, – Bifidobacterium longum,– Lactobacillus bulgaricus

• Placebo capsule : dried milk powder by the same company in similar shape but different color


METHODS:Inclusion criteria– Age >18 y/o, – Informed consent taken from pt’s surrogate,– High likelihood to remain intubated >6 days,– NG tube – Able to receive feeding from NG tube within the

next 24 hrs.Exclusion criteria:– pregnancy, immunosuppression, previous prosthetic

cardiac valve replacement or vascular grafts, cardiac trauma, history of rheumatic fever, endocarditis or congenital cardiac anomalies, traumas to the aerodigestive tract, tracheostomy, pancreatitis, and base of skull fracture.

• 150 pts were allocated in the two treatment groups by computerized random allocation in a 1:1 ratio

• Oropharyngeal cultures were taken on the 1st (before the

intervention), 4th, and 6th days of admission

368


RESULTS:

Cultures of the 1st, 4th, and 6th days were compared

Over all , gram negative bacteria > gram positive species (92.5% vs. 7.5%)

Acinetobacter was the most prevalent PPM in both groups (24.0 % in probiotic group and 22.2% in placebo arm)


RESULTS:

No statistically significant difference was noted in the two arms of the study


limitations of our study:

• long list of exclusion criteria ( lower external but higher internal validity)

• Bacterial growth rates were higher towards the end of the study → longer follow up

OUR MIXED CLOSED INTENSIVIST DRIVEN ICUCENTRAL ICU – NEMAZEE HOSPITAL – SHIRAZ - I.R.IRAN


CONCLUSION:Administration of probiotics to alter early

oropharyngeal cavity infestation with PPM in adult trauma pts admitted in Intensive Care Unit

appears to be non-efficacious, even when a 7- species combination is used.

Thank You 14

effects of a novel seven-species probiotic against oropharyngeal 13.8.94

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