Probiotics in the critical care unit: fad, fact, or fiction?

Heather A. Vitko, Jordan J. Troxell


Thegut microbiome consists of normally non-pathogenic bacteria, viruses, andfungi. These friendly microbes serve to maintain gastrointestinal (GI) barrierfunction and integrity, play a role in host nutrient and drug metabolism,immunomodulation, and prevent pathogenic bacteria from colonizing or causingdisease. Healthy people have used probiotics for centuries to promote andrestore GI health by restoring the normal flora. Probiotics continue tocaptivate consumers in the current health conscious society for theirprovocative health claims. The importance of a healthy microbiome for theoverall health of the host is just recently being appreciated within themedical and science communities, however. Disruption of the microbiome placesone at greater risk for illness and infection. Critically ill patients areamong those at highest risk for complications associated with microbialimbalance, or dysbiosis. Patients being cared for in intensive care units aresubjected to a variety of treatments and therapies that account for a tendencytoward dysbiosis. These include treatment with antibiotics, proton pumpinhibitors, and opioids as well as therapies that require invasive proceduresand monitoring. With the consequential compromise to one’s immunity, criticallyill patients are at the greatest risk for healthcare-associated infections(HAIs). One suggested means to restore immune function and for the preventionof HAIs is to supplement patients with probiotics. Probiotics may serve toprevent and ameliorate the effects of a number of HAIs, including: ventilator-associatedpneumonia (VAP), Clostridium difficile infection (CDI),catheter-associated urinary tract infection (CAUTI), and surgical-siteinfection (SSI). Despite promising findings regarding the efficacy ofprobiotics for a number of conditions, supplementation with probiotics is notwithout risks. Consumers and prescribers must be educated on what probioticscan and cannot do and should understand that not all probiotics are the same.