Probiotic agents in critically ill patients

Probiotics are living organisms which, when ingested in sufficient quantities, confer health benefits upon their host. In this era of increasing antimicrobial resistance, early probiotic studies describing reduced rates of nosocomial infections garnered significant interest, particularly from clinical investigators studying intensive care unit outcomes. Although our current knowledge base is fragmented and limited by various methodologic issues, metaanalysis has been a powerful tool to combine studies and more rigorously assess probiotics’ efficacy in various disease states. The resulting reports suggest that probiotics may reduce overall infection rates – including ventilatorassociated pneumonia and Clostridium difficile infections – in critically ill patients. However, definitive conclusions remain elusive, and rigorous multicenter trials are needed to confirm or refute the findings of these meta-analyses.