Scientist - News - 15-10-2009:

Synbiotics for intensive care patients: shifting the evidence balance
Beintema, Nienke

A combination of pre- and probiotics, so-called synbiotics, improves important health parameters in intensive care patients,according to a recent study. This contradicts some previously published papers.

A study in the Journal of Trauma has recently reopened a several-year-old discussion among trauma specialists. Should intensive care patients be treated with prebiotics and/or probiotics in order to prevent complications, such as bloodstream infections and pneumonia? Some recent studies have found that there is no significant effect of this preventive approach. The newest addition to this discussion, a Greek/British study published in the October issue of the Journal of Trauma, contradicts this with clear statistics.

Pneumonia
The researchers conducted a randomized clinical trial among 72 patients with severe multiple injuries, who received either a placebo of a symbiotic formula (Synbiotic 2000 Forte, containing four lactic acid bacteria and dietary fibre) for fifteen days. Of the patients in the synbiotic group, 14 percent developed a bacterial bloodstream infection, versus 36 percent of the placebo group. The same result was found for the development of ventilator-associated pneumonia, a very common complication among intensive care patients: 14 percent of the symbiotic group developed this condition, versus 33 percent in the placebo group. Treatment with synbiotics was also associated with a significant reduction of three blood markers associated with infection: white blood cell counts, endotoxins, and C-reactive protein.

Meta-analysis
This result contradicts another recent study among intensive care patients, which appeared in the May 2009 edition of Intensive Care Medicine. This New-Zealand study literally concluded that "Synbiotic 2000 Forte has no statistically significant impact on the incidence of ventilator-associated pneumonia in critically ill patients."
Mixed results were reported that same month in a review article in the journal Langenbecks Archives of Surgery. This meta-analysis reviewed fifteen recent clinical studies into the effect of synbiotics on bacterial infection rates. It noted that in ten out of these fifteen studies, synbiotics led to a significant reduction of bacterial infection rates compared to the control groups. It also found that patients after liver or pancreas surgery and multiple trauma patients profited most from synbiotic treatment. This study concluded that "the existing randomized controlled trials demonstrated a positive effect of synbiotics in patients with high-risk operations; however, synbiotic preparations should be extensively tested before using them in clinical trials."

More information:
October 2009 article in the Journal of Trauma
May 2009 article in Intensive Care Medicine
May 2009 review article in Langenbecks Archives of Surgery
An April 2007 article in Clinical Nutrition, showing no significant benefits of synbiotics for intensive care patients