Randomized Controlled Study of Probiotics Containing Lactobacillus casei (Shirota strain) for Prevention of Ventilator-Associated Pneumonia
Yong Rongrungruang MD*, Donnaya Krajangwittaya MD*, Kittisak Pholtawornkulchai MD**, Surapee Tiengrim MSc***, Visanu Thamlikitkul MD*
Affiliation : * Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand *** Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
Objective : To evaluate the efficacy of probiotics, Lactobacillus casei (Shirota strain), in reducing the incidence of ventilator-
associated pneumonia (VAP) in medical patients who received mechanical ventilation at Siriraj Hospital.
Material and Method: A prospective, randomized, open-label controlled trial was conducted in 150 adult hospitalized
patients in medical wards who were expected to receive mechanical ventilation for 72 hours or longer. The patients were
randomized to the probiotics group or the control group. All patients received regular care for mechanical ventilation. The
patients in the probiotics group received 80 ml of Lactobacillus casei (Shirota strain) for oral care after having standard
oral care once daily and additional 80 ml of the aforementioned fermented dairy product was given via enteral feeding once
daily. The primary outcomes were incidence of VAP and incidence rate of VAP episodes per 1,000 ventilator-days. The
secondary outcomes were length of hospital stay, mortality at day 28 and 90, incidence of diarrhea, and presence of resistant
bacteria in oropharyngeal and rectal swab samples taken from the patients at baseline, day 7 and day 28 after enrollment.
Results : The baseline characteristics of the patients in the probiotics group (75) and the control group (75) were not
significantly different. The patients in the probiotics group were less likely to develop VAP compared with the control group
(24% vs. 29.3%, p = 0.46), respectively. The incidence rates of VAP in the probiotics and control groups were 22.64 and
30.22 episodes per 1,000 ventilator-days, respectively (p = 0.37). A trend of lower prevalence of some resistant bacteria
cultured from oropharyngeal swabs in the probiotics group than that in the control group was observed. Overall 28- and
90-day mortality and length of hospital stay of the patients in both groups were not significantly different.
Conclusion : Administration of probiotics containing Lactobacillus casei (Shirota strain) has a tendency to reduce the
incidence of VAP and colonization with resistant bacteria in oropharyngeal cavity without significant effects on mortality
and length of hospital stay.
Keywords : Probiotics, Lactobacillus casei (Shirota strain), Prevention, Ventilator-Associated Pneumonia
