Skip to main content

Advertisement

Log in

Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials

  • Pharmacodynamics
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Background

Advances in surgery have considerably lowered postoperative morbidity. However, infection remains a considerable morbidity factor. The aim of this review is to identify the potential benefit(s) of the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery.

Methods

We searched PubMed, Scopus, Web of Science, and Cochrane library to identify randomized controlled trials (RCTs) that studied the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery.

Results

Nine RCTs studying 733 patients were included in our review. The incidence of postoperative pneumonia, cholangitis, and any infections as well as the duration of postoperative hospital stay and length of antibiotic therapy were lower among patients receiving probiotics than in the control group [six RCTs, 355 patients, odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09–0.68; three RCTs, 209 patients, OR 0.18, 95% CI 0.05–0.57; seven RCTs, 514 patients, OR 0.26, 95% CI 0.12–0.55; five RCTs, 313 patients, OR −2.70, 95% CI −5.15 to −0.25; four RCTs, 250 patients, OR  −4.01, 95% CI −5.11 to −2.92, respectively], while the incidence of postoperative wound infection, urinary tract infection, intra-abdominal abscess, and mortality was not different between patients of the compared groups (six RCTs, 355 patients, OR 0.52, 95% CI 0.23–1.18; five RCTs, 313 patients, OR 0.44, 95% CI 0.04–5.54; four RCTs, 226 patients, OR 0.44, 95% CI  0.12–1.59; nine RCTs, 685 patients, OR 0.98, 95% CI 0.29–3.29, respectively).

Conclusion

The use of probiotics/synbiotics may reduce postoperative infections after abdominal surgery. This is a promising infection-preventive measure that may decrease morbidity, length of antibiotic therapy, duration of hospital stay, and pressure for emergence of antimicrobial resistance. However, the results of this meta-analysis should be interpreted with caution due to the significant heterogeneity of the studies included.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nagino M, Kmiya J, Uesaka K et al (2001) Complications of hepatectomy for hilar cholangiocarcinoma. World J Surg 27:1277–1283

    Article  Google Scholar 

  2. Shigeta H, Nagino M, Kamiya J et al (2002) Bacteremia after hepatectomy: An analysis of single center, 10-year experience with 407 patients. Langenbecks 387:117–124

    Article  Google Scholar 

  3. Tran KT, Smeenk HG, van Eijck CH et al (2004) Pylorus-preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective randomized multicenter analysis of 170 patients with pancreatic periampullary tumours. Ann Surg 240:746–747

    Article  Google Scholar 

  4. Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257

    Article  PubMed  CAS  Google Scholar 

  5. Schroeder RA, Marroquin CE, Phillips Bute B, Khuri S, Henderson WG, Kuo PC (2006) Predictive indices of morbidity and mortality after liver resection. Ann Surg 243:373–379

    Article  PubMed  Google Scholar 

  6. Wang XD, Soltesz V, Anderson R, Bengmark S (1993) Bacterial translocation in acute liver failure induced by 90 per cent hepatectomy in the rat. Br J Surg 80:66–71

    Article  PubMed  CAS  Google Scholar 

  7. Parks RW, Clements WDB, Pope C, Halliday MI, Rowlands BJ, Diamond T (1996) Bacterial translocation and gut microflora in obstructive jaundice. J Anat 189:561–565

    PubMed  Google Scholar 

  8. Macfie J (1997) Bacterial translocation in surgical patients. Ann R Coll Surg Engl 79:183–189

    PubMed  CAS  Google Scholar 

  9. Macfie J, O’Boyle C, Mitchell CJ, Buckley PM, Johnstone D, Sudworth P (1999) Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora and septic morbidity. Gut 45:223–228

    Article  PubMed  CAS  Google Scholar 

  10. Saadia R, Schein M, MacFarlane C, Boffard KD (1990) Gut barrier function and the surgeon. Br J Surg 77:487–492

    Article  PubMed  CAS  Google Scholar 

  11. Welsh FK, Ramsden CW, MacLennan K, Sheridan MB, Barklay GR, Guillou PJ, Reynolds JV (1998) Increased intestinal permeability and altered mucosal jaundice. Ann Surg 227:205–212

    Article  PubMed  CAS  Google Scholar 

  12. Deitch EA (1993) Nutrition and the gut mucosal barrier. Curr Opin Gen Surg 85–91

  13. Lilly D, Stillwell RJ (1965) Probiotics: growth promoting factors produced by microorganisms. Science 147:747–748

    Article  PubMed  CAS  Google Scholar 

  14. Seehofer D, Rayes N, Schiller RA et al (2004) Probiotics partly reverse increased bacterial translocation after simultaneous liver resection and colonic anastomosis in rats. J Surg Res 117:262–271

    Article  PubMed  Google Scholar 

  15. Eizaguirre I, Urkia NG, Asensio AB, Zubillaga I, Zubillaga P, Vidales C, Garcia-Arenzana JM, Aldazabal P (2002) Probiotic supplementation reduces the risk of bacterial translocation in experimental short bowel syndrome. J Pediatr Surg 37:699–702

    Article  PubMed  CAS  Google Scholar 

  16. Schrezenmeier J, de Vrese M (2001) Probiotic, prebiotics, and synbiotics-approaching a definition. Am J Clin Nutr 73:361s–364s

    Google Scholar 

  17. Sugawara G, Nagino M, Nishio H et al (2006) Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery. Ann Surg 244:706–714

    Article  PubMed  Google Scholar 

  18. Reddy BS, Mac Fie J, Gatt M, Larsen CN, Jensen SS, Leser TD (2007) Randomized clinical trial of effect of synbiotics, neomycinand mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg 94:546–554

    Article  PubMed  CAS  Google Scholar 

  19. Rayes N, Seehofer D, Theruvath T et al (2007) Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy. Ann Surg 246:36–40

    Article  PubMed  Google Scholar 

  20. Nomura T, Tsuchiya Y, Nashimoto A et al (2007) Probiotics reduce infectious complications after pancreaticoduodenectomy. Hepatogastroenterology 54:661–663

    PubMed  Google Scholar 

  21. Kanazawa H, Nagino M, Kamiya S et al (2005) Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbeck’s Arch Surg 390:104–113

    Article  Google Scholar 

  22. Rayes N, Seehofer D, Theruvath T et al (2005) Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation – A randomized, double-blind trial. Am J Transplant 5:125–130

    Article  PubMed  Google Scholar 

  23. Anderson ADG, McNaught CE, Jain PK, Macfie J (2004) Randomised clinical trial of synbiotic therapy in elective surgical patients. Gut 53:241–245

    Article  PubMed  CAS  Google Scholar 

  24. Rayes N, Seehofer D, Hansen S et al (2002) Early enteral supply of lactobacillus and fiber versus selective bowel decontamination: A controlled trial in liver transplant recipients. Transplantation 74:123–128

    Article  PubMed  Google Scholar 

  25. Rayes N, Hansen S, Seehofer D et al (2002) Early enteral supply of fiber and lactobacilli versus conventional nutrition: A controlled in patients with major abdominal surgery. Nutrition 18:609–615

    Article  PubMed  Google Scholar 

  26. McNaught CE, Woodcock NP, MacFie J, Mitchell CJ (2002) A prospective randomized study of the probiotic lactobacillus plantarum 299V on indices of gut barrier function in elective surgical patients. Gut 51:827–831

    Article  PubMed  CAS  Google Scholar 

  27. Van Santvoort HC, Besselik MG, Timmerman HM, Van Minnen LP, Akkermans LM, Gooszen HG (2008) Surgical research review. Probiotics in surgery. Surgery 143:1–7

    Google Scholar 

  28. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  PubMed  CAS  Google Scholar 

  29. Sokulova IB, Pinchuk IV, Denayrolles M et al (2007) The safety of two Bacillus probiotics strains for human use. Dig Dis Sci 13

  30. McFarland LV (2007) Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis 5:97–105

    Article  PubMed  Google Scholar 

  31. Uehara S, Monden K, Nomoto K, Seno Y, Kariyama R, Kumon H (2006) A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection. Int J Antimicrob Agents 28:S30–S34

    Article  PubMed  CAS  Google Scholar 

  32. Ledoux D, Labombardi VJ, Karter D (2006) Lactobacillus acidophilus bacteraemia after use of probiotic in a patient with AIDS and Hodgkin’s disease. Int J STD AIDS 17:280–282

    Article  PubMed  Google Scholar 

  33. De Groote MA, Frank DN, Dowell E, Glode MP, Pace NR (2005) Lactobacillus rhamnosus GG bacteraemia associated with probiotic use in a child with short gut syndrome. Pediatr Infect Dis 24:278–280

    Article  Google Scholar 

  34. Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cnota J, Shetty AK (2005) Lactobacillus sepsis associated with probiotic therapy. Pediatrics 115:178–181

    PubMed  Google Scholar 

  35. Young RJ, Vanderhoof JA (2004) Two cases of lactobacillus bacteraemia during treatment of short gut syndrome. J Pediatr Gastroenterol Nutr 38:457–458

    Article  Google Scholar 

  36. Salminen MK, Tynkkynen S, Rautelin H, Saxelin M, Vaara M, Ruutu P, Sarna S, Valtonen V, Jarvinen A (2002) Lactobacillus bacteraemia during a rapid increase in Probiotic use of lactobacillus rhamnosus GG in Finland. Clin Infect Dis 15:1155–1160

    Article  Google Scholar 

  37. Besselink MGH, Van Santvoort HC, Buskens E et al (2008) Probiotic prophylaxis in predicted severe acute pancreatitis: a randomized, double-blind, placebo-controlled trial. Lancet 371:651–659

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors state that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthew E. Falagas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pitsouni, E., Alexiou, V., Saridakis, V. et al. Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 65, 561–570 (2009). https://doi.org/10.1007/s00228-009-0642-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-009-0642-7

Keywords

Navigation