Probiotics, Antibiotic, Diarrhea

''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''

Šibenik, 12.-15. travnja 2012. godine

Background: Frequent antibiotic use in the ICU patients usually suffers from antibiotic-associated diarrhea (AAD) and consequently having severe complications such as sepsis and leading to unnecessary increase of health care costs. Therefore, the aim of the present study is to evaluate the effects of probiotics to prevent AAD by improving intestinal function.
Methods: A patient / problem intervention comparison of intervention clinical outcome (PICO) problem was formed by the five Evidence-Based Nursing (EBN) steps in this study. AAD and probiotics were regarded as two main key words to search the relevant articles by using a range of medical search sites, including Cochrane library, BMJ Clinical Evidence , PubMed, etc. With the exclusion of literature of non- Clostridium difficile-associated diarrhea, there were three articles selected regarding Lactobacillus and Bifidobacterium. The first article on the Meta-Analysis showed that the ADD risk of patients with receiving probiotic treatment was 0.35 times lower than others, especially in the adult group (RR: 0.44, 95% CI 0.18 ~ 1.08). The other two articles of randomised controlled trials showed the beneficial effects of using probiotics in preventing AAD. The Absolute Risk Reduction (ARR) of the patients with or without probiotics were 22% and 3.3%, and the Number needed to treat (NNT) 5 and 30 respectively.
According to the evidence in the above literature, researchers at Mackay Memorial Hospital developed a selection criteria, educational programs of medical staff and patient instructions, and so forth.With patients’ informed consents, within 48 hours after antibiotics were used, Infloran of 250mg twice daily was prescribed for the enrolled patients for 14 days.During the 2-week period, assessments and records of defecation characteristics were performed.
The Study Results: From March to May 2011, five patients were selected in the project.Three of them were diarrhea-free with defecation frequency of 1~2 times per day, while the other two had suffered from diarrhea since the date that antibiotics were prescribed.The initial results showed that defecation frequency of the latter two patients was reduced to 1~3 times after using probiotics with the stool shape from watery to formed.The use of probiotics may be helpful in patients with AAD regarding defecation frequency and related characteristics.
Conclusion: The project will be carried out in the other intensive care units if there will be more beneficial evidence noted by using probiotics in this regard.

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