Volume 1 Issue 5 - 2017
Probiotics, Prebiotics and Symbiotics to overcome ICU-Acquired Infections and Antibiotic resistance: Beneficial or Risky?
Farid Menaa*
Farid Menaa, R&D Director, California Innovations Corp. Department of Advanced Internal Medicine San Diego, CA, USA
*Corresponding Author: Farid Menaa, Farid Menaa, R&D Director, California Innovations Corp. Department of Advanced Internal Medicine San Diego, CA, USA.
Received: September 05, 2017; Published: September 07, 2017
Keywords: Public health; Probiotics, Prebiotics, Symbiotic; ICU-acquired infections; Antibiotic resistance
Abbreviations: ICU: Intensive Care unit
How to maintain the homeostasis between commensal intestinal micro biota (mostly anaerobic bacteria) and pathogenic bacteria? Could we use probiotics or symbiotic to overcome antibiotic resistance and ICU-related infections? Are they a possible cause of inflammatory-state diseases/symptoms, or are they safely and efficiently beneficial for the same? Such questions are often the center of debates.
The last two decades have seen an emerging and considerable interest in probiotics and prebiotics due to their potential health benefits, which are not restricted to their effects on the Human gastrointestinal tract (GIT) (Menaa 2015; Iannitti., et al. 2010; McNabb and Isakow 2008: Gibson and Roberfroid 1995). In critically ill patients, gut barrier and immune dysfunction is associated with the onset of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) (Manzanares and Hardy 2008; Alverdy., et al. 2003). It is worthwhile noting that most of the studies related to the benefits of probiotics and synbiotics on chronic ill patients are controversial (McNaught., et al. 2005; Alberda., et al. 2007).
The concept of probiotics was first described by Metchnikoff in 1907 (Iannitti., et al. 2010). Probiotics are defined as “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host” (WHO 2015; Iannitti., et al. 2010; McNaught., et al. 2005). Most probiotics are derived from bacteria (e.g. Lactobacillus, Enterococcus and Bifidobacterium) or yeasts (e.g. Saccharomyces boulardi) that do no elicit virulence properties or antibiotic resistance (Morrow 2009; Madsen 2008; Gibson and Roberfroid 1995).
These agents are referred as synbiotics (e.g. Synbiotic 2000 Forte, VSL#3) only when they are administered to prebiotics, i.e. no digestible food components that are believed to control bacterial colonization and growth (Knight., et al. 2009; Madsen 2008; Gibson and Roberfroid 1995).
In spite of possible health benefits of current probiotic and synbiotics preparations, the mechanisms of action exerted by probiotic preparations need further clarifications. To date, their anti-infectious effects (e.g. against ICU-acquired infections including severe sepsis and nocosomial infections, predominantly caused by Gram-negative bacteria) are thought to be performed locally (e.g. reduced overgrowth of pathogens either directly or competitively to avoid “colonization resistance” (McNaught ., et al. 2005)) and systemically (e.g. improved gut mucosal barrier function, reduced bacterial translocation and up-regulated immune function) (Knight., et al. 2009; Manzanares and Hardy 2008; Van Minnen., et al. 2007; Jain., et al. 2004). Furthermore, there is still insufficient evidence that probiotic uses lower the incidence of respiratory tract infections (e.g. pneumonia) (McNabb and Isakow 2008), could even be associated with several mild adverse events in such clinical context (Siempos., et al. 2010).
Eventually, well-designed, large-scale, multicenter, randomized clinical trials should then determine the real health benefits of current (marketed or intended to be marketed) probiotic and symbiotic preparations, by clearly specify their values in terms of dosages, duration of administration, adverse effects/safety and efficacy in order to avoid any speculations.
The author thanks Dr. Abder Menaa, MD, specialist in Nutrition, for our fruitful discussions on this important public health matter.
  1. Alberda C., et al. “Effects of probiotic therapy in critically ill patients: a randomized, double-blind, placebo-controlled trial.”  American Journal of Clinical Nutrition 85.3 (2007): 816-823.
  2. Alverdy John C. et al. “Influence of the critically ill state on host-pathogen interactions within the intestine: Gut-derived sepsis redefined.” Critical Care Medicine 31.2 (2003): 598-607.
  3. Madsen K.  “Probiotics in critically ill patients”. Journal of Clinical Gastroenterology42.S3 (2008): 116-118.
  4. Manzanares W and Hardy G.  “The role of prebiotics and synbiotics in critically ill patients”. Current Opinion in Clinical Nutrition & Metabolic Care 11.6 (2008): 782-789.
  5. McNabb B and Isakow W.  “Probiotics for the prevention of nosocomial pneumonia: current 74 evidence and opinions”. Current Opinion in Pulmonary Medicine 14.3 (2008):168-175.
  6. McNaught CE., et al.  “A prospective randomised trial of 77 probiotics in critically ill patients”. Clinical Nutrition24.2 (2005): 211-219.
  7. Menaa F.  “Are Probiotics Pro-Obesity or Potential Anti-Obesity Agents?”  International Journal of Food and Nutritional Science2.2 (2015).
  8. Gibson GR and Roberfroid MB: “Dietary modulation of the human colonic microbiota: 83 introducing the concept of prebiotics”. Journal of Nutrition125. 6 (1995): 1401-1412.
  9. Iannitti T and Palmieri B. “Therapeutical use of probiotic formulations in clinical practice”. Clinical Nutrition 29.6 (2010): 701-725.
  10. Jain PK., et al. “Influence of synbiotic containing Lactobacillus acidophilus La5, Bifidobacterium lactis Bb 12, Streptococcus thermophilus, Lactobacillus bulgaricus and oligofructose on gut barrier function and sepsis in critically ill patients: a randomised controlled trial”. Clinical Nutrition 23. 4 (2004): 467-475.
  11. Knight DJ., et al. “Effect of synbiotic therapy on the incidence of ventilator associated pneumonia in critically ill patients: a randomised, double- blind, placebo-controlled trial”. Intensive Care Medicine 35.5 (2009): 854-861.
  12. Morrow LE., et al. “Probiotics in the intensive care unit”. Current Opinion in Critical Care 27.2 (2012): 235-241.
  13. Siempos., et al. “Impact of the administration of probiotics on the 100 incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials”. Critical Care Medicine 38.3 (2010): 954-962.
  14. Van Minnen LP., et al. “Modification of  intestinal flora with multispecies probiotics reduces bacterial translocation and improves clinical course in a rat model of acute pancreatitis”. Surgery 141.4 (2007): 470-480.
Citation: Farid Menaa. “Probiotics, Prebiotics and Symbiotics to overcome ICU-Acquired Infections and Antibiotic resistance: Beneficial or Risky?” Nutrition and Food Toxicology 1.5 (2017): 192-194.
Copyright: © 2017 Farid Menaa. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.