%0 Journal Article
%T Treating critically ill patients with probiotics: Beneficial or dangerous?
%A Christoph A Jacobi
%A Christian Schulz
%A Peter Malfertheiner
%J Gut Pathogens
%D 2011
%I BioMed Central
%R 10.1186/1757-4749-3-2
%X Severe sepsis with associated multisystem organ dysfunction is a leading cause of death in patients hospitalized in intensive care units (ICU). The gastrointestinal tract plays an important role in the pathogenesis of multiorgan dysfunction owing to a breakdown of intestinal barrier function and increased translocation of bacteria and bacterial components into the systemic circulation. During critical illness, alterations in gut microflora are due to several factors that include changes in circulating stress hormones, gut ischemia, immunosuppression, the use of antibiotics and other drugs, possible bacterial translocation and the lack of nutrients [1]. In experimental models of pancreatitis, it has been demonstrated, that Lactobacillus strains disappear after 6 to 8 hours from the gut and are replaced by an overgrowth of pathogenic bacteria [2]. The importance of endogenous strains of probiotic bacteria such as Bifidobacterium and Lactobacillus in maintaining intestinal barrier function by modulating mucosal and systemic immune responses is becoming evident from numerous studies [3]. Also the airways can be colonized by pathogens, due to broad-spectrum antibiotic use, reduction in gastric pH as part of the stress ulcer prophylaxis, and the impairment of mucosal defense mechanisms due to trauma induced by indwelling endotracheal or nasogastric tubes [4]. In fact, ventilator associated pneumonia (VAP) occur in 9-27% of patients maintained on mechanical ventilation for more than 48 h. VAP is associated with a mortality of 10-40%, increased ICU and hospital stay and an estimated cost of between US$ 12.000 to US$ 16.000 per episode [5,6]. Thus, interest has been developed in utilizing probiotics as colonizers to prevent the cycle of colonization with pathogens and ultimately nosocomial infections [7]. Thus the therapeutic concept with probiotics is an effort to reduce or eliminate potential pathogens and toxins, to release nutrients, antioxidants, growth factors and coag
%U http://www.gutpathogens.com/content/3/1/2