Aim: The efficacy of probiotic Lactobacillus casei (Shirota strain) in reducing incidence of ventilator-associated pneumonia (VAP) in medical patients who received mechanical ventilation at Siriraj Hospital was evaluated.
Method: A prospective, randomized, open-label controlled trial was conducted on 150 adult hospitalized patients in medical wards who were on mechanical ventilation for 72 hours or longer: The patients were randomized to the probiotic group or the control group. The patients in the probiotic group received 80 ml of a probiotic fermented milk drink containing 8 billion Lactobacillus casei (Shirota strain) for oral care after having standard oral care once daily and additional 80 ml of the aforementioned fermented dairy product was given via enteral feeding once daily. The primary outcomes were incidence of VAP and incidence rate of VAP episodes per 1,000 ventilator-days. The secondary outcomes were length of hospital stay, mortality at day 28 and 90, incidence of diarrhea, and presence of resistant bacteria in oropharyngeal and rectal swab samples taken from the patients at baseline, day 7 and day 28 after enrollment.
Results: The baseline characteristics of the patients in the probiotic group (75) and the control group (75) were not significantly different. The patients in the probiotic group were less likely to develop VAP compared with the control group (24% vs. 29.3%, p = 0.46). The incidence rates of VAP in the probiotic and control groups were 22.64 and 30.22 episodes per 1,000 ventilator-days, respectively (p = 0.37). A trend of lower prevalence of resistant bacteria cultured from oropharyngeal swabs in the probiotic group than that in the control group was observed. Overall 28 and 90-day mortality and length of hospital stay of the patients in both groups was not significantly different.
Conclusions: Administration of probiotic containing Lactobacillus casei (Shirota strain) resulted in a tendency to reduce the incidence of VAP and colonization with resistant bacteria in oropharyngeal cavity without significant effects on mortality and length of hospital stay.
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Aim: Although several studies have demonstrated the efficacy of probiotics for preventing upper respiratory tract infections (URTIs) in at-risk populations, including children and the elderly. Few studies have investigated the efficacy of probiotics in healthy adults living normal, everyday lives. Thus, this study evaluated the effect of Lactobacillus casei strain Shirota-fermented milk (LcS-FM) on the incidence of URTIs in healthy middle-aged office workers.
Method: In a randomized controlled trial, 96 male workers aged 30–49 years consumed LcS-FM containing 1.0 × 1011 LcS bacteria or control milk (CM) once daily for 12 weeks during the winter season. URTI episodes were evaluated by a physician via a questionnaire of URTI symptoms.
Results: The incidence of URTIs during the intervention period was significantly lower in the LcS-FM group as compared to the CM group (22.4 vs. 53.2 %, P = 0.002). The time to-event analysis showed that the LcS-FM group had a significantly higher URTI-free rate than the CM group over the test period (log-rank test: χ2 11.25, P = 0.0008). The cumulative number of URTI episodes and cumulative days with URTI symptoms per person was lower in the LcS-FM group, and the duration per episode was shorter. Inhibition of both reductions in NK cell activity in peripheral blood mononuclear cells and increase in salivary cortisol levels was observed in the LcS-FM group.
Conclusions: The results suggest that the daily intake of fermented milk with LcS may reduce the risk of URTIs in healthy middle-aged office workers, probably through modulation of the immune system.
Aim: There is insufficient evidence of preventive effect of probiotics on upper respiratory tract infections (URTIs) in an elderly population.
Method: A multicenter, double-blinded, randomized, placebo-controlled parallel group study was conducted. Elderly persons had participated who used day care at 4 facilities in Tokyo. We used fermented milks containing Lactobacillus casei strain Shirota (LcS) and placebo drinks as test drinks.
Results: A total of 154 subjects was analyzed. The number of persons diagnosed with an acute URTIs was almost identical in both groups (LcS: 31, placebo: 32), whereas the number of acute URTIs events (LcS: 68, placebo: 51) and the symptom score (LcS: 425, placebo: 396) were both higher in the LcS group. Permutation tests performed using the total number of acute URTIs infection events/total days of observation and the total symptom score/total days of observation found no statistically significant difference respectively (P values of .89 and .64, respectively). Comparing the mean duration of infection per infection event found a shorter mean duration in the LcS group (LcS: 3.71 days, placebo: 5.40 days), and the difference was statistically significant.
Conclusions: The results suggest that fermented milk containing LcS probably reduces the duration of acute URTIs.
Aim: This pilot study investigated the effects of the probiotic Lactobacillus casei strain Shirota (LcS) on psychological and physical stress responses in medical students undertaking an authorized Nationwide examination for promotion.
Method: In a double-blind, placebo-controlled trial, 24 and 23 healthy medical students consumed a fermented milk containing LcS and a placebo milk, respectively, once a day for 8 weeks until the day before the examination. Psychological state, salivary cortisol, faecal serotonin and plasma L-tryptophan were analysed on 5 different sampling days (8 weeks before examination, 2 weeks before examination, 1 day before examination, immediately after examination and 2 weeks after the examination). Physical symptoms were also recorded in a dairy by subjects during the intervention period for 8 weeks.
Results: In association with a significant elevation of anxiety at 1 day before the examination, salivary cortisol and plasma L-tryptophan levels were significantly increased in only the placebo group (P < 0.05). Two weeks after the examination, the LcS group had significantly higher faecal serotonin levels (P < 0.05) than the placebo group. Moreover, the rate of subjects experiencing common abdominal and cold symptoms and total number of days experiencing these physical symptoms per subject were significantly lower in the LcS group than in the placebo group during the pre-examination period at 5-6 weeks (each P < 0.05) and 7-8 weeks (each P < 0.01) during the intervention period.
Conclusions: The results suggest that daily consumption of fermented milk containing LcS may exert beneficial effect by preventing the onset of physical symptoms in healthy subjects exposed to stressful situations.
5. Decreased duration of acute upper respiratory tract infections with daily intake of fermented milk: A multicenter, double-blinded, randomized comparative study in users of day care facilities for the elderly population.
Fujita R, Iimuro S, Shinozaki T, Sakamaki K, Uemura Y et al (2013) Am J Infect Control pii: S0196-6553(13)00846-8. doi: 10.1016/j.ajic.2013.04.005.