Volume 40 Supplement 2
The role of probiotics in nosocomial infections
© Zuccotti and Meneghin; licensee BioMed Central Ltd. 2014
Published: 9 October 2014
Nosocomial infections are among the leading causes of mortality and morbidity especially in neonatal intensive care unit (NICU) . The intestinal microbiota of the gut is nowadays considered to play an important functional role in the host’s health through nutritional, physiological and immunological processes. For these reasons, probiotics may exert actions of prevention and therapy of infectious diseases.
The mechanisms of action of probiotics are strain specific but can be summarized mainly in three areas: changes of gut ecology, modulation of gut mucosal barrier and regulation of the immune response through interaction with gut-associated immune system . Several studies regarding the supplementation of probiotics in nosocomial infections have been conducted mainly in adult population. Among pediatric studies major findings have been observed in treatment of acute gastroenteritis, primarily caused by Rotavirus [3, 4], and in the prevention of antibiotic associated diarrhea (AAD) . Supplementation with probiotics has proven useful even in the treatment of Clostridium difficile disease (CDD), the most common pathogen involved in AAD . Data from meta-analysis and cochrane review on the prevention of necrotizing enterocolitis (NEC) show an overall benefit of probiotic supplementation . The limitations of the above cited studies are mainly related to heterogeneity in terms of strain, dosage and duration of treatment and the lack of studies on extremely low birth weight preterm infants. Data on nosocomial pneumonia and ventilator-associated pneumonia in neonatal and pediatric age is scanty. In a large randomized, double-blind placebo controlled study, Hojsak et al demonstrated that supplementation with Lactobacillus GG significantly decreased the risk of nosocomial respiratory tract infections . On the other hand, the data from adult studies have been conflicting, with a tendency towards the demonstration of probiotic efficacy in reducing the incidence of ventilator-associated pneumonia . Meticillin-resistant Staphylococcus aureus is a multidrug-resistant nosocomial pathogen; a recent review of literature  showed that many probiotic strains inhibit MRSA growth in vitro. Furthermore, this review describes that there is little published clinical data on the use of probiotics in prophylaxis or treatment of MRSA-mediated infections.
Due to the significant heterogeneity between the studies in literature it is not possible to draw consistent conclusions on extensive use of probiotics in prevention and treatment of nosocomial infections, except for acute gastroenteritis, AAD, CDD and NEC.
- Polin RA, Denson S, Brady MT: Epidemiology and Diagnosis of Health Care–Associated Infections in the NICU. Pediatrics. 2012, 129: e1104-e1109.View ArticlePubMedGoogle Scholar
- Kotzampassi K, Giamarellos-Bourboulis EJ: Probiotics for infectious diseases: more drugs, less dietary supplementation. International Journal of Antimicrobial Agents. 2012, 40: 288-296. 10.1016/j.ijantimicag.2012.06.006.View ArticlePubMedGoogle Scholar
- Allen SJ, Martinez EG, Gregorio GV: Probiotics for treating acute infectious diarrhoea (Review). Cochrane Database of Systematic Reviews. 2010, CD003048-10.1002/14651858.CD003048.pub3. 11
- Guarino A, Ashkenazi S, Gendrel D, Vecchio AL, Shamir R, Szajewska H: European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe: Update 2014. JPGN. 2014, 59: 132-152.PubMedGoogle Scholar
- McFarland LV: Meta-Analysis of Probiotics for the Prevention of Antibiotic Associated Diarrhea and the Treatment of Clostridium difficile Disease Meta-Analysis of Probiotics for the Prevention of Antibiotic Associated Diarrhea and the Treatment of Clostridium difficile Disease. Am J Gastroenterol. 2006, 101: 812-822. 10.1111/j.1572-0241.2006.00465.x.View ArticlePubMedGoogle Scholar
- Goldenberg JZ, Ma SSY, Saxton JD, Martzen MR, Vandvik PO, Thorlund K, Guyatt GH, Johnston BC: Probiotics for the prevention of Clostridium difficile associated diarrhea in adults and children. Cochrane Database of Systematic Reviews. 2013, CD006095-10.1002/14651858.CD006095.pub3. 5
- AlFaleh K, Anabrees J, Bassler D: Probiotics for prevention of necrotizing enterocolitis in preterm infants . Cochrane Database of Systematic Reviews. 2011, CD005496-10.1002/14651858.CD005496.pub3. 3
- Hojsak I, Abdovic S, Szajewska H, Milosevic M, Krznaric Z, Kolacek S: Lactobacillus GG in the Prevention of Nosocomial Gastrointestinal and Respiratory Tract Infections. Pediatrics. 2010, 125: e1171-e1177. 10.1542/peds.2009-2568.View ArticlePubMedGoogle Scholar
- Siempos II, Ntaidou TK, Falagas ME: Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: A meta-analysis of randomized controlled trials. Crit Care Med. 2010, 38: 954-962. 10.1097/CCM.0b013e3181c8fe4b.View ArticlePubMedGoogle Scholar
- Sikorska H, Smoragiewicz W: Role ofprobioticsinthepreventionandtreatmentof meticillin-resistant Staphylococcus aureus infections. International Journal of Antimicrobial Agents. 2013, 42: 475-481. 10.1016/j.ijantimicag.2013.08.003.View ArticlePubMedGoogle Scholar
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