Synbiotics for prevention of ventilator-associated pneumonia: a probiotics strain-specific network meta-analysis.

OBJECTIVE

Probiotics may be efficacious in preventing ventilator-associated pneumonia (VAP). The aim of this network meta-analysis (NMA) was to clarify the efficacy of different types of probiotics for preventing VAP.

METHODS

This systematic review and NMA was conducted according to the updated preferred reporting items for systematic review and meta-analysis. A systematic literature search of public databases from inception to 17 June 2018 was performed.

RESULTS

NMA showed that “ +  + ” was more efficacious than “” in preventing VAP (odds ratio: 0.15, 95% confidence interval: 0.03–0.94). According to pairwise meta-analysis, “ +  + ” and “” were superior to placebo in preventing VAP. Treatment rank based on surface under the cumulative ranking curves revealed that the most efficacious treatment for preventing VAP was “ +  + ” (66%). In terms of reducing hospital mortality and ICU mortality, the most efficacious treatment was Synbiotic 2000FORTE (34% and 46%, respectively).

CONCLUSIONS

Based on efficacy ranking, “ +  + ” should be the first choice for prevention of VAP, while Synbiotic 2000FORTE has the potential to reduce in-hospital mortality and ICU mortality.