The safety and efficacy of probiotic supplementation for critically ill adult patients: a systematic review and meta-analysis

CONTEXT: The safety and efficacy of probiotics during severe illness has been a subject of ongoing interest. The impact of probiotics can worsen nutritional status, which could potentially result in a deterioration of the patient’s overall life-threatening status. OBJECTIVE: This systematic review and meta-analysis evaluated the safety and efficacy of probiotics in reducing intensive care unit (ICU)–acquired infections in adult critically ill patients. DATA SOURCES: PubMed and Cochrane library databases for the period 2011–2020 were searched. DATA EXTRACTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) methodology was used to search for randomized controlled trials that evaluated the use of probiotics among critically ill patients. DATA ANALYSIS: No significant difference was observed between probiotics and control groups in terms of the mortality rate (risk ratio 1.13, 95% confidence interval .82 to 1.55, P = .46). Probiotics, however, provided a significant reduction in ICU-acquired infections (risk ratio .73, 95% confidence interval .58 to .93, P = .01). CONCLUSION: The use of probiotics seems to play a role in decreasing the incidence of ICU-acquired infections. Also, a potential reduction in terms of the incidence of diarrhea has been reported, with no examples of adverse incidents, suggesting probiotics are safe.