Ventilator associated pneumonia (VAP) is a possible severe complication of patient management in intensive care units (ICUs). VAP was estimated to occur in 9-27 % of all mechanically ventilated patients and the attributable mortality for VAP at between 33-50 %.
The most significant mechanisms implicated in the insurgence of VAP depends by micro aspiration, which can occur during intubation and micro aspiration around the cuff of the tube and pooling and trickling of secretions around the cuff. The complex interplay between the endotracheal tube, virulence of the pathogens and presence of risk factors contribute to the development of VAP. For these reasons the potential strategy to prevent VAP are a key topic.
Current data suggested that probiotics are able to reduce the incidence of VAP in patients undergoing mechanical ventilation. However, despite preliminary evidence indicates that probiotics are safe and efficacious in preventing VAP in ICUs and may reduce the incidence of VAP in this setting, the quality of the available evidences is low and large well-built studies are needed to clarificate this topic.
The aim of this study is to verify the reduction of incidence of VAP in a cohort of patient hospedalized in ICU receiving oral bacteriotherapy compared with untreated.
Innovation of the project:
this project aims to reduce the risk of VAP by using a non pharmacological approach able to modulate host microflora. With the reduction of the related prescription of antibiotics, we hope to control the emergence of MDR infections in UTI
Possible applications of the project:
Current literature evidence showing promising (but also discordant) data on the utility of probiotic supplementation in VAP prevention. Several meta-analyzes show that the available studies are currently burdened by unclear methodologies and small numbers of enrolled patients. This project aims to understand the real applicability of this interesting non-pharmacological tool in the prevention of VAP by applying a methodology based on the availability of a sufficient number of patients for statistical analysis, by the presence of a control group, by the randomization of the sample. furthermore, the quality of the data will be stimulated by the analysis of variations in the microbiome to understand the possible mechanisms involved in the eventual reduction of the incidence of VAPs following prophylaxis with probiotics. In the event that the data of a reduction in the incidence of VAPs following the prophylaxis with probiotics was confirmed, this type of strategy could be applied in patients admitted to intensive care and subjected to mechanical ventilation.
Scientific and economic impact of the project:
the benefits obtained would be to reduce the impact of ventilator-associated pneumonia, thus reducing all the costs induced by this pathology. In particular, a reduction in both the duration of hospitalization and the mortality associated with assisted ventilation is expected, as well as a reduction of the costs of antibiotic therapy (reduction in expenditure on medicines, but also in potential adverse effects). Furthermore, it should be emphasized that this non-pharmacological approach (based on the data reported in the literature) is burdened with far more modest potential rare side effects than those expected in the pharmacological treatment of any VAP.