Document Detail


Pro- and synbiotics to control inflammation and infection in patients with multiple injuries.
MedLine Citation:
PMID:  19820590     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A recent randomized clinical trial of our group disclosed considerable reduction of the infective sequelae after administration of a synbiotic formula, namely Synbiotic 2000FORTE, in patients with multiple injuries, the latter being a preparation of four probiotics. The mechanism of action of synbiotics was studied. METHODS: A total of 72 patients with severe multiple injuries were allocated to a 15-day administration of either placebo or the synbiotic formula. The association of bloodstream infections, ventilator-associated pneumonia (VAP), serum levels of C-reactive protein (CRP), and endotoxins (LPS) were studied. RESULTS: Sepsis in the field of bacteremia occurred in 13 patients treated with placebo (36.1%) compared with 5 patients treated with Synbiotic 2000FORTE (13.9%, p = 0.028 between groups). The time to progression to primary bacteremia was longer among patients treated with Synbiotic 2000FORTE compared with placebo (p = 0.0237 between groups). Twelve (33.3%) and five (13.9%) placebo-treated and probiotic-treated patients, respectively, developed ventilator-associated pneumonia with Acinetobacter baumannii as a bacterial cause (p = 0.047 between groups). Treatment with synbiotics was accompanied by reduction of white blood cell counts and LPS and CRP levels in either patients who did or did not develop sepsis. CONCLUSIONS: Synbiotics contained in the studied formula decrease significantly the risk for sepsis by bloodstream infections and the occurrence of VAP by A. baumannii. The mechanisms of action might involve direct immunomodulatory effect, prevention of bacterial translocation, or most likely a combination of both.
Authors:
Evangelos J Giamarellos-Bourboulis; Stig Bengmark; Kyriaki Kanellakopoulou; Katerina Kotzampassi
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Journal of trauma     Volume:  67     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-12     Completed Date:  2009-12-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  815-21     Citation Subset:  AIM; IM    
Affiliation:
4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece. giamarel@ath.forthnet.gr
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MeSH Terms
Descriptor/Qualifier:
APACHE
Actinobacteria
Bacterial Infections / prevention & control
Critical Illness
Cross Infection / prevention & control
Gram-Positive Bacterial Infections / prevention & control
Humans
Middle Aged
Multiple Trauma / complications*
Pneumonia, Ventilator-Associated / microbiology,  prevention & control
Polysaccharides / therapeutic use*
Probiotics / therapeutic use*
Systemic Inflammatory Response Syndrome / prevention & control
Chemical
Reg. No./Substance:
0/Polysaccharides

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