We hear a lot about hospital infections and the risk of surving a procedure only to be struck by some nasty oppertunistic bacterial infection a few days later. This can happen despite the use of preventative (prophylactic) antibiotics and there is growing worries that such wide-spread use of antibiotics in patients has contributed to the emergence of multiresistant bacteria.
New evidence is acculumating indicating a positive role for the use of probiotics to help correct the disrupted gut microflora that appears to occur after surgery, and in so doing help prevent post-operative infections. In surgical patients altered microflora in the gut are associated with altered gut barrier function leading to an enhanced inflammatory response to surgery. Several experimental and clinical studies have shown that probiotics (mainly lactobacilli) may reduce the number of potentially pathogenic bacteria and restore a deranged barrier function.
The question therefore arises; can probiotics can be utilized as a pre-operative prophylactic or by perioperative administration of probiotics in addition to antibiotics. To investigate this, fourteen randomized clinical trials were analysed in which the effect of such regimens has been tested. It seems that in patients undergoing liver transplantation or elective surgery in the upper gastrointestinal tract prophylactic administration of different probiotic strains in combination with different fibers results in a three-fold reduction in postoperative infections and a reduction in postoperative inflammation, although that has not been studied in a systematic way. However, the use of similar concepts in colorectal surgery has not been successful in reducing postoperative infections. Reasons for this difference are not obvious. It may be that higher doses of probiotics with longer duration are needed to influence microflora in the lower gastrointestinal tract or that immune function in colorectal patients may not be as important as in transplantation or surgery in the upper gastrointestinal tract.
The study authours commented that the favorable results for the use of prophylactic probiotics in some settings warrant further controlled studies to discover potential mechanisms, impact on gut microbiota and influence on clinical management.
Learn more about probiotics here: www.pearlslife.eu
Key article: Jeppsson B, Mangell P, Thorlacius H. Use of Probiotics as Prophylaxis for Postoperative Infections. Nutrients 2011, 3, 604-612; doi:10.3390/nu3050604