Synbiotics associated with lower secondary infection rates in sepsis

Prophylactic synbiotics could modulate the gut microbiota and environment and may have preventive effects on the incidence of enteritis and ventilator-associated pneumonia (VAP) in patients with sepsis, reports a study published in the journal Critical Care.

Commensal microbiota deteriorates in critically ill patients. The preventive effects of probiotic/synbiotic therapy on microbiota and septic complications have not been thoroughly clarified in patients with sepsis.

Kentaro Shimizu and associates conducted a study to evaluate whether synbiotics have effects on gut microbiota and reduce complications in mechanically ventilated patients with sepsis.

The randomized study included sepsis patients who were mechanically ventilated in the intensive care unit (ICU). Patients receiving daily synbiotics (Bifidobacterium breve strain Yakult, Lactobacillus casei strain Shirota, and galactooligosaccharides) initiated within 3 days after admission (the Synbiotics group) were compared with patients who did not receive synbiotics (the No-Synbiotics group).

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The primary outcome was infectious complications including enteritis, ventilator-associated pneumonia (VAP), and bacteremia within 4 weeks from admission. The secondary outcomes included mortality within 4 weeks, fecal bacterial counts, and organic acid concentration. Enteritis was defined as the acute onset of continuous liquid stools for more than 12 h.

Key study findings:

• The incidence of enteritis was significantly lower in the Synbiotics than the No-Synbiotics group (6.3% vs. 27.0%).


• The incidence of VAP was also significantly lower in the Synbiotics than the No-Synbiotics group (14.3% vs. 48.6%).


• The incidence of bacteremia and mortality did not differ significantly between the two groups.


• In the analysis of fecal bacteria, the number of Bifidobacterium and Lactobacillus in the Synbiotics group was significantly higher than that in the No-Synbiotics group.


• In the analysis of fecal organic acids, total organic acid concentration, especially the amounts of acetate, were significantly greater in the Synbiotics group than in the No-Synbiotics group during the first week.

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The study concluded that septic patients in the ICU experienced lower rates of ventilator-associated pneumonia (VAP) and enteritis when treated with synbiotics.

Probiotics are defined by the Food and Agriculture Organization (FAO)/World Health Organization (WHO) as live microorganisms which, when administered in adequate amounts, confer a health benefit on the host and are widely used as a live microbial food supplement that can improve the intestinal microbial balance. Synbiotics is a combination of probiotics and prebiotics.

For reference log on to https://doi.org/10.1186/s13054-018-2167-x