Les probiotiques dans la prévention des pneumopathies acquises sous ventilation mécanique

Ventilator-associated pneumonia (VAP) represents the first cause of hospital-acquired infection in intensive care units (ICU). VAP is associated with increased mortality, duration of mechanical ventilation, ICU stay and health care costs. Prevention of colonization of the upper and lower digestive tract is a major approach for the prevention of VAP. Probiotics are live bacteria who could play a role in the prevention of this colonization and so decrease the incidence of VAP. The published clinical studies are contradictory but a recent meta-analysis shows that the administration of probiotics is associated with a lower incidence of VAP. The analysis of the results highlights several disparities between these studies. Indeed, the type of studies, the diagnostic criteria of VAP, the used probiotics, the route and number of daily administration, the study population are variable from one study to another and so generate confusion. Probiotics may have a protective effect on the colonization with Pseudomonas aeruginosa but the data are not sufficient. On the other hand, the administration of a probiotic does not seem to impact on all-cause mortality during ICU stay or on the duration of the mechanical ventilation. There is a strong rational to perform additional studies on the prevention of the VAP with the use of probiotics while performing a strict monitoring of potential infectious side effects.