An open-label study into the efficacy and dosing of probiotic Escherichia coli Nissle 1917 for the prevention of gram-negative gastric colonisation in ventilated intensive care patients

Crooks, Neil Harvey (2019). An open-label study into the efficacy and dosing of probiotic Escherichia coli Nissle 1917 for the prevention of gram-negative gastric colonisation in ventilated intensive care patients. University of Birmingham. M.D.

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Abstract

Twenty-five percent of hospital infections occur in critical care patients. Up to 30% of these develop ventilator associated pneumonia, increasing length of stay, morbidity, mortality and cost. Causative bacteria are predominantly Gram-negative, and with increasing multidrug-resistant strains, we must look towards non-antibiotic strategies in prevention and treatment. Probiotics are one option in this quest; however, efficacy and mechanisms of action are unclear. The randomised controlled trials of probiotics to date, have predominantly used Gram-positive bacteria and varied in their inclusion criteria, sample size and population studied, in addition to formula, dosing and route of administration. These studies have yielded conflicting results, however, there is some evidence that ventilator associated pneumonia can be prevented by probiotic treatment.

This thesis demonstrates successful gastric colonisation by probiotic Escherichia coli Nissle 1917 in ventilated patients. Trends toward dose-dependent incidence, and time to colonisation were observed, but these were not statistically significant. In the 15 millilitre treatment group, there was a significant reduction in the burden of pathogenic Gram-negative bacteria in gastric aspirates after 48 hours. Probiotic Escherichia coli Nissle 1917 can be safely administered to a selected group of critically ill patients. As a reduction in pathogenic Gram-negative gastric colonisation has been demonstrated, further study is warranted to determine if this leads to a reduction in the incidence of ventilator associated pneumonia.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):