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Use of Probiotics as Prophylaxis for Postoperative Infections
Department of Surgery, Lund University and Skane University Hospital, Malmo, SE 205 02, Sweden
* Author to whom correspondence should be addressed.
Received: 29 March 2011; in revised form: 26 April 2011 / Accepted: 28 April 2011 / Published: 12 May 2011
Abstract: Postoperative bacterial infections are common despite prophylactic administration of antibiotics. The wide-spread use of antibiotics in patients has contributed to the emergence of multiresistant bacteria. A restricted use of antibiotics must be followed in most clinical situations. In surgical patients there are several reasons for an altered microbial flora in the gut in combination with an altered 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 pathogenia bacteria (PPM) and restore a deranged barrier function. It is therefore of interest to test if these abilities of probiotics can be utilized in preoperative prophylaxis. These factors may be corrected by perioperative administration of probiotics in addition to antibiotics. Fourteen randomized clinical trials have been presented 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. In parallel there seems to be a reduction in postoperative inflammation, although that has not been studied in a systematic way. 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 microbiota 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 favorable results for the use of prophylactic probiotics in some settings warrant further controlled studies to elucidate potential mechanisms, impact on gut microbiota and influence on clinical management. The use of probiotics must be better delineated in relation to type of bacteria, dose and length of administration.
Keywords: probiotics; postoperative infections; immune function; bacterial translocation; gastrointestinal surgery; liver transplantation
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MDPI and ACS Style
Jeppsson, B.; Mangell, P.; Thorlacius, H. Use of Probiotics as Prophylaxis for Postoperative Infections. Nutrients 2011, 3, 604-612.
Jeppsson B, Mangell P, Thorlacius H. Use of Probiotics as Prophylaxis for Postoperative Infections. Nutrients. 2011; 3(5):604-612.
Jeppsson, Bengt; Mangell, Peter; Thorlacius, Henrik. 2011. "Use of Probiotics as Prophylaxis for Postoperative Infections." Nutrients 3, no. 5: 604-612.