Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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It has been proposed that probiotics can favorably influence the course of critically ill patients. To address this question, a limited systematic review was undertaken (MEDLINE search for articles published in English) to identify randomized, controlled trials that compared a group of critically ill patients taking probiotics with a group that did not. Ten such trials, mostly with high risks of methodologic bias, were identified. ⋯ The largest of these, and the one with the lowest risk of bias, demonstrated that probiotics increased mortality, in part because of the precipitation of ischemic bowel disease (in patients who were also receiving postpyloric enteral nutrition infusions). Probiotics also appeared to reduce the incidence of antibiotic-associated diarrhea in hospitalized patients, although these trials did not specifically focus only on those who were critically ill. In summary, it is not clear that probiotics are beneficial (and they may even be harmful) in the critically ill patient group.