• Edward Litton, Matt Anstey, David Broadhurst, Andy Chapman, Andrew Currie, Janet Ferrier, Joel Gummer, Alisa Higgins, Jolene Lim, Laurens Manning, Erina Myers, Katrina Orr, Anne-Marie Palermo, Andrea Paparini, Susan Pellicano, Edward Raby, Anu Rammohan, Adrian Regli, Bernhard Richter, Sam Salman, Tobias Strunk, Sharon Waterson, David Weight, Bradley Wibrow, and Fiona Wood.
• Intensive Care Unit, Fiona Stanley Hospital, Murdoch, 6150, Australia. ed_litton@hotmail.com.
• Intensive Care Med. 2021 Mar 1; 47 (3): 307-315.

PurposeIn adults requiring treatment in an intensive care unit, probiotic therapy using Lactobacillus plantarum 299v may reduce nosocomial infection. The aim of this study was to determine whether early and sustained L. plantarum 299v therapy administered to adult ICU patients increased days alive and at home.MethodsA multicentre, parallel group, placebo-controlled, randomised clinical trial was conducted. Adult patients within 48 h of intensive care admission and expected to require intensive care beyond the day after recruitment were eligible to participate. L plantarum 299v or placebo were administered immediately after enrolment and continued for 60 days. The primary outcome was days alive and out of hospital to Day 60 (DAOH60). Secondary outcomes included nosocomial infections.ResultsThe median [interquartile range (IQR)] number of DAOH60 in the probiotic (n = 110) and placebo group (n = 108) was 49.5 (IQR 37.0-53.0) and 49.0 (IQR 43.8-53.0) respectively, between-group difference of 0.0 [95% confidence interval (CI) - 6.10 to 7.1, P = 0.55]. Nosocomial infection occurred in 8 (7.3%) and 5 (4.6%) of the probiotic and placebo group participants, respectively, odds ratio 1.62 (95% CI 0.51-5.10), P = 0.57. There were no serious, or probiotic-associated adverse events.ConclusionEarly and sustained untargeted administration of probiotic therapy with Lactobacillus plantarum 299v to adult patients admitted to the ICU is safe, but not associated with improved patient outcomes.

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