Effectiveness Not Established

Probiotics

for Prevention of Infection: General

Probiotics are live microorganisms capable of colonizing the intestinal tract, altering the microflora, and exerting a positive effect on the host. The mechanism by which probiotics exert positive effects remains to be elucidated. However, purported mechanisms include antagonizing pathogens through the production of antimicrobial or antibacterial compounds, decreasing gut pH by stimulating lactic-acid producing bacteria, preventing colonization of pathogenic microorganisms by competing for binding sites, improving immune function, competing with pathogens for nutrients and growth factors, producing lactase to aid lactose digestion, and signaling cells to stop production of virulence factors. Probiotics have been used for the treatment of diarrhea and constipation. Preoperative probiotics were examined for prevention of infection in patients undergoing colorectal surgery.

Research Evidence Summaries

Sadahiro, S., Suzuki, T., Tanaka, A., Okada, K., Kamata, H., Ozaki, T., & Koga, Y. (2014). Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: Prospective randomized trial. Surgery, 155, 493–503.

Study Purpose

To determine comparative effectiveness of oral antibiotics and probiotics as bowel preparation in the prevention of surgical site infection (SSI)

Intervention Characteristics/Basic Study Process

Patients were randomized to one of three groups. The probiotic group took bifidobacteria tablets orally after each meal three times daily for seven days preoperatively, and postoperatively for 10 days. The oral antibiotic group took 0.5 g kanamycin sulfate and 0.5 g metronidazole orally three times on the day before surgery. The control group did not receive any bowel preparation beyond standard care. All patients underwent mechanical bowel prep with sodium picosulfate two days before surgery and polyethylene glycol in the morning of the day of surgery. All patients received a single preoperative 1 g dose of flomoxef IV one hour prior to incision. The same procedures for surgical site disinfection, intraperitoneal irrigation, and suture closures were done. Operative wounds were assessed daily during the hospital stay and in an outpatient clinic four weeks after surgery.

Sample Characteristics

  • N = 294
  • MEAN AGE = 66.5 years
  • MALES: 53.1%, FEMALES: 46.9%
  • KEY DISEASE CHARACTERISTICS: All had colon cancer. Patients who had resection of adjacent organs were excluded. Seventy-three percent had open procedures, and the rest had laparoscopic procedures.

Setting

  • SITE: Single site 
  • SETTING TYPE: Inpatient 
  • LOCATION: Japan

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

  • RCT
    • Three-group
    • Single-blind

Measurement Instruments/Methods

  • SSI was classified as incisional or organ/space SSI.
  • Stool samples were collected prior to surgery and on postoperative days 7 and 14 for analysis of fecal flora and Clostridium difficile (CD) toxin.

Results

Rates of postoperative infections, including incisional infections, organ/space SSIs, and remote infections, were 24% in the probiotic group, 11.1% in the oral antibiotic group, and 25% in the control group. Group comparisons showed that the difference in infection rate was significantly lower in the oral antibiotic group than in either other group (p < .03). Incidence of incisional SSI was lower in the oral antibiotic group (p = .014). The oral antibiotic group also had a significantly lower rate of leakage (p = .004). SSI-causing pathogens were analyzed in all patients, and most of the bacteria detected were not covered by the spectrum of flomoxef. No significant differences were observed in CD toxin detection between groups.

Conclusions

Findings suggest that bowel preparation with oral antibiotics is helpful in preventing postoperative infections in patients with colon cancer undergoing elective colon surgery. No benefit was shown with the use of preoperative probiotics.

Limitations

  • Measurement/methods not well described
  • Other limitations/explanation: Definition of SSI was described minimally.

Nursing Implications

Findings show that rates of postoperative infections among patients undergoing surgery for colon cancer can be reduced by the addition of oral antibiotics as part of bowel preparation. Probiotic use was not effective. Nurses can advocate for consideration of use of preoperative oral antibiotics as examined in this study and advocate for further research to confirm these findings. CD risk was not shown to be different across groups in this study, but this risk remains a consideration, particularly if oral antibiotic use is prolonged.

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