Probiotics and synbiotics for the prevention of postoperative infections following abdominal surgery

A systematic review and meta-analysis of randomized controlled trials

L. Lytvyn, K. Quach, L. Banfield, B. C. Johnston, D. Mertz

Research output: Contribution to journalReview article

Abstract

Background: Postoperative infections, particularly surgical site infections (SSIs), cause significant morbidity and mortality. Probiotics or synbiotics are a potential prevention strategy. Aim: To evaluate the efficacy of probiotics/synbiotics for reducing postoperative infection risk following abdominal surgery. Methods: We searched AMED, Central, CINAHL, Embase, Medline, and grey literature for randomized controlled trials of elective abdominal surgery patients administered probiotics or synbiotics compared to placebo or standard care. Primary outcome was SSIs. Secondary outcomes were adverse events, respiratory tract infections (RTIs), urinary tract infections (UTIs), combined infections, length of hospital stay, and mortality. Using random-effects meta-analyses, we estimated the relative risk (RR) or mean difference (MD) and 95% confidence interval (CI). Tests were performed for heterogeneity, subgroup and sensitivity analyses were conducted, and the overall evidence quality was graded. Findings: We identified 20 trials (= 1374 participants) reporting postoperative infections. Probiotics/synbiotics reduced SSIs (RR: 0.63; 95% CI: 0.41-0.98; N = 15 studies), UTIs (RR: 0.29; 95% CI: 0.15-0.57; N = 11), and combined infections (RR: 0.49; 95% CI: 0.35-0.70; N = 18). There was no difference between groups for adverse events (RR: 0.89; 95% CI: 0.61-1.30; N = 6), RTIs (RR: 0.60; 95% CI: 0.36-1.00; N = 14), length of stay (MD: -1.19; 95% CI: -2.94 to 0.56; N = 12), or mortality (RR: 1.20; 95% CI: 0.58-2.48; N = 15). Conclusion: Our review suggests that probiotics/synbiotics reduce SSIs and UTIs from abdominal surgeries compared to placebo or standard of care, without evidence of safety risk. Overall study quality was low, owing mostly to imprecision (few patients and events, or wide CIs); thus larger multi-centered trials are needed to further assess the certainty in this estimate.

Original languageEnglish (US)
Pages (from-to)130-139
Number of pages10
JournalJournal of Hospital Infection
Volume92
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

Fingerprint

Synbiotics
Probiotics
Meta-Analysis
Randomized Controlled Trials
Confidence Intervals
Surgical Wound Infection
Infection
Urinary Tract Infections
Length of Stay
Respiratory Tract Infections
Placebos
Literature
Mortality
Standard of Care
Hospital Mortality

Keywords

  • Abdominal surgery
  • Postsurgical infections
  • Prevention
  • Probiotics
  • Surgical site infections
  • Synbiotics

ASJC Scopus subject areas

  • Medicine(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Probiotics and synbiotics for the prevention of postoperative infections following abdominal surgery : A systematic review and meta-analysis of randomized controlled trials. / Lytvyn, L.; Quach, K.; Banfield, L.; Johnston, B. C.; Mertz, D.

In: Journal of Hospital Infection, Vol. 92, No. 2, 01.02.2016, p. 130-139.

Research output: Contribution to journalReview article

@article{4030909c530342858f0f101c5b8287e3,
title = "Probiotics and synbiotics for the prevention of postoperative infections following abdominal surgery: A systematic review and meta-analysis of randomized controlled trials",
abstract = "Background: Postoperative infections, particularly surgical site infections (SSIs), cause significant morbidity and mortality. Probiotics or synbiotics are a potential prevention strategy. Aim: To evaluate the efficacy of probiotics/synbiotics for reducing postoperative infection risk following abdominal surgery. Methods: We searched AMED, Central, CINAHL, Embase, Medline, and grey literature for randomized controlled trials of elective abdominal surgery patients administered probiotics or synbiotics compared to placebo or standard care. Primary outcome was SSIs. Secondary outcomes were adverse events, respiratory tract infections (RTIs), urinary tract infections (UTIs), combined infections, length of hospital stay, and mortality. Using random-effects meta-analyses, we estimated the relative risk (RR) or mean difference (MD) and 95{\%} confidence interval (CI). Tests were performed for heterogeneity, subgroup and sensitivity analyses were conducted, and the overall evidence quality was graded. Findings: We identified 20 trials (= 1374 participants) reporting postoperative infections. Probiotics/synbiotics reduced SSIs (RR: 0.63; 95{\%} CI: 0.41-0.98; N = 15 studies), UTIs (RR: 0.29; 95{\%} CI: 0.15-0.57; N = 11), and combined infections (RR: 0.49; 95{\%} CI: 0.35-0.70; N = 18). There was no difference between groups for adverse events (RR: 0.89; 95{\%} CI: 0.61-1.30; N = 6), RTIs (RR: 0.60; 95{\%} CI: 0.36-1.00; N = 14), length of stay (MD: -1.19; 95{\%} CI: -2.94 to 0.56; N = 12), or mortality (RR: 1.20; 95{\%} CI: 0.58-2.48; N = 15). Conclusion: Our review suggests that probiotics/synbiotics reduce SSIs and UTIs from abdominal surgeries compared to placebo or standard of care, without evidence of safety risk. Overall study quality was low, owing mostly to imprecision (few patients and events, or wide CIs); thus larger multi-centered trials are needed to further assess the certainty in this estimate.",
keywords = "Abdominal surgery, Postsurgical infections, Prevention, Probiotics, Surgical site infections, Synbiotics",
author = "L. Lytvyn and K. Quach and L. Banfield and Johnston, {B. C.} and D. Mertz",
year = "2016",
month = "2",
day = "1",
doi = "10.1016/j.jhin.2015.08.028",
language = "English (US)",
volume = "92",
pages = "130--139",
journal = "Journal of Hospital Infection",
issn = "0195-6701",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Probiotics and synbiotics for the prevention of postoperative infections following abdominal surgery

T2 - A systematic review and meta-analysis of randomized controlled trials

AU - Lytvyn, L.

AU - Quach, K.

AU - Banfield, L.

AU - Johnston, B. C.

AU - Mertz, D.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background: Postoperative infections, particularly surgical site infections (SSIs), cause significant morbidity and mortality. Probiotics or synbiotics are a potential prevention strategy. Aim: To evaluate the efficacy of probiotics/synbiotics for reducing postoperative infection risk following abdominal surgery. Methods: We searched AMED, Central, CINAHL, Embase, Medline, and grey literature for randomized controlled trials of elective abdominal surgery patients administered probiotics or synbiotics compared to placebo or standard care. Primary outcome was SSIs. Secondary outcomes were adverse events, respiratory tract infections (RTIs), urinary tract infections (UTIs), combined infections, length of hospital stay, and mortality. Using random-effects meta-analyses, we estimated the relative risk (RR) or mean difference (MD) and 95% confidence interval (CI). Tests were performed for heterogeneity, subgroup and sensitivity analyses were conducted, and the overall evidence quality was graded. Findings: We identified 20 trials (= 1374 participants) reporting postoperative infections. Probiotics/synbiotics reduced SSIs (RR: 0.63; 95% CI: 0.41-0.98; N = 15 studies), UTIs (RR: 0.29; 95% CI: 0.15-0.57; N = 11), and combined infections (RR: 0.49; 95% CI: 0.35-0.70; N = 18). There was no difference between groups for adverse events (RR: 0.89; 95% CI: 0.61-1.30; N = 6), RTIs (RR: 0.60; 95% CI: 0.36-1.00; N = 14), length of stay (MD: -1.19; 95% CI: -2.94 to 0.56; N = 12), or mortality (RR: 1.20; 95% CI: 0.58-2.48; N = 15). Conclusion: Our review suggests that probiotics/synbiotics reduce SSIs and UTIs from abdominal surgeries compared to placebo or standard of care, without evidence of safety risk. Overall study quality was low, owing mostly to imprecision (few patients and events, or wide CIs); thus larger multi-centered trials are needed to further assess the certainty in this estimate.

AB - Background: Postoperative infections, particularly surgical site infections (SSIs), cause significant morbidity and mortality. Probiotics or synbiotics are a potential prevention strategy. Aim: To evaluate the efficacy of probiotics/synbiotics for reducing postoperative infection risk following abdominal surgery. Methods: We searched AMED, Central, CINAHL, Embase, Medline, and grey literature for randomized controlled trials of elective abdominal surgery patients administered probiotics or synbiotics compared to placebo or standard care. Primary outcome was SSIs. Secondary outcomes were adverse events, respiratory tract infections (RTIs), urinary tract infections (UTIs), combined infections, length of hospital stay, and mortality. Using random-effects meta-analyses, we estimated the relative risk (RR) or mean difference (MD) and 95% confidence interval (CI). Tests were performed for heterogeneity, subgroup and sensitivity analyses were conducted, and the overall evidence quality was graded. Findings: We identified 20 trials (= 1374 participants) reporting postoperative infections. Probiotics/synbiotics reduced SSIs (RR: 0.63; 95% CI: 0.41-0.98; N = 15 studies), UTIs (RR: 0.29; 95% CI: 0.15-0.57; N = 11), and combined infections (RR: 0.49; 95% CI: 0.35-0.70; N = 18). There was no difference between groups for adverse events (RR: 0.89; 95% CI: 0.61-1.30; N = 6), RTIs (RR: 0.60; 95% CI: 0.36-1.00; N = 14), length of stay (MD: -1.19; 95% CI: -2.94 to 0.56; N = 12), or mortality (RR: 1.20; 95% CI: 0.58-2.48; N = 15). Conclusion: Our review suggests that probiotics/synbiotics reduce SSIs and UTIs from abdominal surgeries compared to placebo or standard of care, without evidence of safety risk. Overall study quality was low, owing mostly to imprecision (few patients and events, or wide CIs); thus larger multi-centered trials are needed to further assess the certainty in this estimate.

KW - Abdominal surgery

KW - Postsurgical infections

KW - Prevention

KW - Probiotics

KW - Surgical site infections

KW - Synbiotics

UR - http://www.scopus.com/inward/record.url?scp=84958034831&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958034831&partnerID=8YFLogxK

U2 - 10.1016/j.jhin.2015.08.028

DO - 10.1016/j.jhin.2015.08.028

M3 - Review article

VL - 92

SP - 130

EP - 139

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

SN - 0195-6701

IS - 2

ER -