Probiotics in the intensive care unit

Probiotic Properties of Pediococcus pentosaceus JBCC 106 and Its Lactic Acid Fermentation on Broccoli Juice

To understand the biological roles of Pediococcus pentosaceus strains as probiotics isolated from the traditional Korean fermented food, Jangajji, Pediococcus pentosaceus was selected based on its high cinnamoyl esterase (CE) and antioxidant activities. The acid and bile stability, intestinal adhesion, antagonistic activity against human pathogens, cholesterol-lowering effects, and immune system stimulation without inflammatory effects were evaluated. Nitric oxide (NO) levels were measured in co-culture with various bacterial stimulants. Fermentation ability was measured by using a broccoli matrix and the sulforaphane levels were measured. Resistance to acidic and bilious conditions and 8% adherence to Caco-2 cells were observed. Cholesterol levels were lowered by 51% by assimilation. Moreover, these strains exhibited immunomodulatory properties with induction of macrophage TNF-α and IL-6 and had microstatic effects on various pathogens. Co-culture with various bacterial stimulants resulted in increased NO production. Fermentation activity was increased with the strains, and higher sulforaphane levels were observed. Therefore, in the future, the applicability of the selected strain to broccoli matrix-based fermented functional foods should be confirmed.

Investigating the effect of oral synbiotic on enteral feeding tolerance in critically ill patients: A double-blinded controlled clinical trial of gut microbiota

BACKGROUND

Probiotics are beneficial live microorganisms that can modify the gut microbiota. It is assumed that they help improve enteral feeding intolerance (EFI) and nosocomial infections in critically ill patients. The present clinical trial aimed to investigate the efficacy of synbiotics in improving EFI and oropharyngeal aspiration in patients admitted to the intensive care unit (ICU).

METHODS

This randomized clinical trial was conducted on 105 critically ill patients admitted to the ICU of a tertiary referral hospital affiliated with a medical university. The patients were randomly assigned to either a synbiotic or control group and underwent 7 days of investigation. The primary end point was reduced gastric residual volume, which is suggestive of an improvement in EFI. The secondary end point included requirement for prokinetics, frequency of aspiration, duration of mechanical ventilation, length of ICU stay, and level of consciousness.

RESULTS

The present clinical trial showed that synbiotic intervention has resulted in a significantly diminished requirement for prokinetics (P = 0.019), fewer oropharyngeal aspirations (P = 0.01), improved volume of bolus administration, and decreased gastric residual volume during the 7-day follow-up period. The patients who received synbiotic had an improved level of consciousness (P = 0.01).

CONCLUSION

This clinical trial showed that the prescription of synbiotic from the initial days of enteral feeding has resulted in a significantly diminished requirement for prokinetics, less oropharyngeal aspiration, decreased gastric residual volume, improved volume of bolus administration, and hence, better tolerance of enteral feeding.

Optimization of Therapy and the Risk of Probiotic Use during Antibiotherapy in Septic Critically Ill Patients: A Narrative Review

Optimizing the entire therapeutic regimen in septic critically ill patients should be based not only on improving antibiotic use but also on optimizing the entire therapeutic regimen by considering possible drug–drug or drug–nutrient interactions. The aim of this narrative review is to provide a comprehensive overview on recent advances to optimize the therapeutic regimen in septic critically ill patients based on a pharmacokinetics and pharmacodynamic approach. Studies on recent advances on TDM-guided drug therapy optimization based on PK and/or PD results were included. Studies on patients <18 years old or with classical TDM-guided therapy were excluded. New approaches in TDM-guided therapy in septic critically ill patients based on PK and/or PD parameters are presented for cefiderocol, carbapenems, combinations beta-lactams/beta-lactamase inhibitors (piperacillin/tazobactam, ceftolozane/tazobactam, ceftazidime/avibactam), plazomicin, oxazolidinones and polymyxins. Increased midazolam toxicity in combination with fluconazole, nephrotoxic synergism between furosemide and aminoglycosides, life-threatening hypoglycemia after fluoroquinolone and insulin, prolonged muscle weakness and/or paralysis after neuromuscular blocking agents and high-dose corticosteroids combinations are of interest in critically ill patients. In the real-world practice, the use of probiotics with antibiotics is common; even data about the risk and benefits of probiotics are currently spares and inconclusive. According to current legislation, probiotic use does not require safety monitoring, but there are reports of endocarditis, meningitis, peritonitis, or pneumonia associated with probiotics in critically ill patients. In addition, probiotics are associated with risk of the spread of antimicrobial resistance. The TDM-guided method ensures a true optimization of antibiotic therapy, and particular efforts should be applied globally. In addition, multidrug and drug–nutrient interactions in critically ill patients may increase the likelihood of adverse events and risk of death; therefore, the PK and PD particularities of the critically ill patient require a multidisciplinary approach in which knowledge of clinical pharmacology is essential.

Isolation and Characterization of Lactobacillus crispatus, Lactococcus lactis, and Carnobacterium divergens as Potential Probiotic Bacteria from Fermented Black and Green Olives (Olea europaea): An Exploratory Study

Background

Table olives are becoming well recognized as a source of probiotic bacteria that might be used to create a health-promoting fermented food product by traditional procedures based on the activities of indigenous microbial consortia present in local environments. Methodology. In the present study, the characterization of probiotic bacteria isolated from mince, chunks, and brine of fermented green and black olives (Olea europaea) was done based on morphological, biochemical, and physiological characteristics.

Results

Bacterial isolates demonstrated excellent survival abilities at 25, 37, and 45°C and at a variable range of pH. However, the optimum temperature is 37 and the optimum pH is 7 for all three isolates. An antimicrobial susceptibility pattern was found among these isolates through the disc diffusion method. Most of the isolates were susceptible to streptomycin, imipenem, and chloramphenicol, whereas, amoxicillin showed resistance to these isolates, and variable results were recorded for the rest of the antibiotics tested. The growth of the isolates was optimum with the supplementation of 3% NaCl and 0.3% bile salt. The isolated bacteria were able to ferment skimmed milk into yogurt, hence making it capable of producing organic acid.

Conclusion

Isolates of Lactobacillus crispatus MB417, Lactococcus lactis MB418 from black olives, and Carnobacterium divergens MB421 from green olives were characterized as potential candidates for use as starter cultures to induce fermentation of other probiotic food products.

Antioxidant and Antibacterial Effects of Potential Probiotics Isolated from Korean Fermented Foods

A total of sixteen bacterial strains were isolated and identified from the fourteen types of Korean fermented foods that were evaluated for their in vitro probiotic potentials. The results showed the highest survivability for Bacillus sp. compared to Lactobacillus sp. in simulated gastric pH, and it was found to be maximum for B. inaquosorum KNUAS016 (8.25 ± 0.08 log10 CFU/mL) and minimum for L. sakei KNUAS019 (0.8 ± 0.02 log10 CFU/mL) at 3 h of incubation. Furthermore, B. inaquosorum KNUAS016 and L. brevis KNUAS017 also had the highest survival rates of 6.86 ± 0.02 and 5.37 ± 0.01 log10 CFU/mL, respectively, in a simulated intestinal fluid condition at 4 h of incubation. The percentage of autoaggregation at 6 h for L. sakei KNUAS019 (66.55 ± 0.33%), B. tequilensis KNUAS015 (64.56 ± 0.14%), and B. inaquosorum KNUAS016 (61.63 ± 0.19%) was >60%, whereas it was lower for L. brevis KNUAS017 (29.98 ± 0.09%). Additionally, B. subtilis KNUAS003 showed higher coaggregation at 63.84 ± 0.19% while B. proteolyticus KNUAS001 found at 30.02 ± 0.33%. Among them, Lactobacillus sp. showed the best non-hemolytic activity. The highest DPPH and ABTS radical scavenging activity was observed in L. sakei KNUAS019 (58.25% and 71.88%). The cell-free supernatant of Lactobacillus sp. considerably inhibited pathogenic growth, while the cell-free supernatant of Bacillus sp. was moderately inhibited when incubated for 24 h. However, the overall results found that B. subtilis KNUAS003, B. proteolyticus KNUAS012, L. brevis KNUAS017, L. graminis KNUAS018, and L. sakei KNUAS019 were recognized as potential probiotics through different functional and toxicity assessments.

Production of plant-based fermented beverages possessing functional ingredients antioxidant, γ-aminobutyric acid and antimicrobials using a probiotic Lactiplantibacillus plantarum strain L42g as an efficient starter culture

Plant-based probiotic beverages have gained increasing interest due to demand from health-conscious consumers. In this study, we aimed to isolate and screen lactic acid bacteria possessing functional properties for use as a starter culture of fermented almond and coix beverages. Lactiplantibacillus plantarum L42g isolated from fermented beef was selected. Both intact cells and cell free supernatant of this strain exhibited high antioxidant activity based on 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging at 38.2% and 44.9%, respectively. L. plantarum L42g grown in MRS broth supplemented with 1% (w v^-1) monosodium glutamate (MSG) produced a large amount of γ-aminobutyric acid (GABA) at 496.7 μg mL^-1. Moreover, strain L42g displayed remarkable antibacterial activity against several potential foodborne bacterial pathogens, including Bacillus cereus, Listeria monocytogenes, Listeria inocua, Staphylococcus aureus, Streptococcus agalactiae, Escherichia coli, Salmonella enterica subsp. enterica serovar Typhimurium, Shigella sp., Vibrio cholerae and Vibrio parahaemolyticus. Strain L42g also possessed additional probiotic properties including abilities to tolerate gastrointestinal conditions, adhere to gut mucosa, co-aggregate with pathogens, be susceptible to antibiotics, and produce protease. Probiotic strain L42g was subsequently employed in fermenting almond and coix juices containing MSG (1%) supplementation. Levels of antioxidant, GABA and antibacterial formation along with cell growth were clearly higher in fermented almond juice than in fermented coix juice. Nonetheless, both fermented almond and coix juices meet the standards required for the consumption of fermented beverages. Therefore, L. plantarum strain L42g represents a promising starter culture for producing functional plant-based probiotic beverages.

In Vitro Probiotic Characteristics and Whole Genome Sequence Analysis of Lactobacillus Strains Isolated from Cattle-Yak Milk

Cattle-yak milk is an important raw material and an indispensable source of high-quality food for local farmers and herdsmen to produce ghee, milk residue, yogurt, and other dairy products. In this study, Lactobacillus strains were isolated from cattle-yak milk for potential probiotic candidates using a series of in vitro tests, including probiotic characterization and safety evaluation (antibiotic susceptibility and hemolytic ability). The results found that the Lactobacillus rhamnosus CY12 strain showed a high survival rate in bile salts, under acid conditions, and in the gastrointestinal juice environment, as well as showing high antimicrobial activity and adhesive potential. The safety evaluation showed that all strains were considered non-hemolytic. In addition, the whole-genome sequencing indicated that the strain CY12 spanned 2,506,167 bp, with an average length of 881 bp; the GC content in the gene region (%) was 47.35, contained 1347 protein-coding sequences, and accounted for 85.72% of the genome. The genome annotation showed that genes mainly focused on the immune system process, metabolic process, carbohydrate utilization, carbon metabolism, galactose metabolism, and biological adhesion, etc. This study revealed that the Lactobacillus rhamnosus CY12 strain might be an excellent potential probiotic in the development of feed additives for animals and has the ability to promote health.

When and How Job Design Influences Work Motivation: A Self-Determination Theory Approach

Based on self-determination theory and job characteristics theory, this study aims to provide a systematic and comprehensive model simultaneously investigating the relationship between job characteristics and two forms of work motivation (i.e., controlled motivation and autonomous motivation). To examine the proposed model, we recruited employees working in multiple Chinese industries and collected 435 valid questionnaires. The results indicate that job characteristics have a significantly positive effect on basic psychological needs satisfaction, which, in turn, positively affects autonomous motivation and negatively influences controlled motivation. In addition, basic psychological needs satisfaction mediates the linkage between job characteristics and positive or negative work motivation. Moreover, when an employee had high positive affectivity, job characteristics were more likely to fuel their basic psychological needs satisfaction. In contrast, job characteristics were more likely to be the depressor of these needs satisfaction when an employee possesses high negative affectivity. Our findings revealed that the degree of three needs satisfaction at work is a convincing and identifiable psychological mechanism between job characteristics and two types of work motivation. Also, work affectivity may influence the different perceptions of job characteristics, reminding managers that personality traits are a non-negligible factor in job design. Overall, this paper extends the application of the job characteristics model by revealing when and how job characteristics influence two types of work motivation and further puts forward managerial implications.

The prospects of employing probiotics in combating COVID-19

Unanticipated pathogenic risk and emerging transmittable diseases can result from interspecies exchanges of viruses among animals and humans. The emergence of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing coronavirus disease-19 (COVID-19) pandemic has recently exemplified this mechanism. Cough, fever, fatigue, headache, sputum production, hemoptysis, dyspnea, diarrhea, and gastrointestinal disorders are the characteristic features of the disease. The most prevalent and serious manifestation of the infection tends to be pneumonia. The new strains of SARS-CoV-2 with more infectivity have been emerging at regular intervals. There is currently no World Health Organization-approved particular drug for COVID-19. Besides, developing novel antivirals would take much time. Thus, repurposing the application of natural products can provide alternatives and can facilitate medication against COVID-19 as well as can slow down the aggressive progression of the disease before the arrival of approved drugs. Probiotics have long been known for their positive effects on the gut microbiome and impact on immune responses. Particularly, their involvement against viral diseases, especially those of the upper and lower respiratory tract, is of current interest for their prospective application against COVID-19. In this review, we comprehensively address the mode of action of probiotics and their possible intervention against coronavirus diseases correlating with their efficacy against viral diseases. In this regard, we explored recently published relevant research and review articles in MEDLINE/PubMed related to COVID-19 and the effects of probiotics on viral infections.

Preventive Effect of Probiotics on Ventilator-Associated Pneumonia: A Meta-analysis of 2428 Patients

BACKGROUND

Researchers had contradictory conclusions about the role of probiotics in preventing ventilator-associated pneumonia (VAP), which has led to the controversial use of probiotics in mechanically ventilated patients.

OBJECTIVE

To explore the efficacy and safety of probiotics in preventing VAP.

METHODS

A literature search was conducted in 7 medical databases. Two investigators assessed literature quality independently and collected data. The primary outcome was the incidence of VAP. Secondary outcomes included 16 measures. Sensitivity analysis and subgroup and meta-regression analyses were performed to analyze the source of heterogeneity. P values <0.05 were considered statistically significant, and CIs were set at 95%. A random-effects model was set when I² <50%, otherwise a fixed-effects model was used.

RESULTS

A total of 20 randomized controlled studies with a total of 2428 patients were analyzed. Pooled results showed positive effects of probiotics on the reduction of VAP incidence (risk ratio [RR] = 0.672; P < 0.001; I² = 11.3%), length of ICU stay (WMD = -1.417; P = 0.012; I² = 90.7%), oropharyngeal (RR = 0.866; P = 0.031; I² = 12.4%) and gastric (RR = 0.645; P < 0.001; I² = 30.2%) colonization.

CONCLUSIONS AND RELEVANCE

Probiotics can reduce the incidence of VAP and reduce oropharyngeal and gastric bacterial colonization. The results also suggest that probiotics do not cause adverse effects.

Letter: role of probiotics in the COVID-19 pandemic

LINKED CONTENT This article is linked to Tian et al and Tian and Rong papers. To view these articles, visit https://doi.org/10.1111/apt.15731 and https://doi.org/10.1111/apt.15931

Isolation and identification of potential probiotic Lactobacillus species from feces of infants in southwest Iran

OBJECTIVES

To evaluate the potential probiotic properties of Lactobacillus strains isolated from feces of infants and also to determine their antimicrobial activity against some enteropathogenic bacteria.

METHODS

The Fecal samples were prepared from 120 infants aged less than 24 months. In total, 105 Lactobacillus strains were identified by phenotypic tests. Thirty isolates were randomly selected to study their potential probiotic properties. These isolates were examined for resistance to acid (pH: 2.5, 2 h) and bile (oxgall 0.3%, 8 h), adhesion to HT-29 cells, antibiotic susceptibility, and antimicrobial activities.

RESULTS

On basis of 16S rRNA sequencing, 30 isolates identified as Lactobacillus fermentum (n = 11; 36.7%), Lactobacillus plantarum (n = 9; 30%), Lactobacillus rhamnosus (n = 6; 20%), and Lactobacillus paracasei (n = 4; 13.3%). All tested strains survived at acid and bile conditions. Six Lactobacillus strains revealed high adherence to HT-29 cells. Three strains including the L. fermentum (N2, N7), and the L. plantarum (N20) showed good probiotic potential and inhibited the growth of Yersinia enterocolitica ATCC 23715, Shigella flexneri ATCC 12022, Salmonella enterica ATCC 9270, and enteropathogenic Escherichia coli (EPEC) ATCC 43887. The antibiotic resistance test showed that all the isolates were susceptible to tetracycline, and chloramphenicol.

CONCLUSIONS

Lactobacillus strains like L. fermentum (N2, N7), and the L. plantarum (N20), could be potential probiotic, but further in vitro and in vivo studies on these probiotic strains are still required.

Multifunctional properties of Lactobacillus plantarum strains WiKim83 and WiKim87 as a starter culture for fermented food

This study aimed to evaluate the safety (hemolysis and enzyme activity), probiotic properties (gastrointestinal tract tolerance, adhesion, hydrophobicity, and auto-aggregation), and functional characteristics (antimicrobial, antioxidant, and β-galactosidase activities) of lactic acid bacteria (LAB), isolated from kimchi, in order to select a multifunctional LAB strain for starter culture in fermented food. The five isolated strains included Lactobacillus plantarum WiKim83, L. plantarum WiKim84, Pediococcus pentosaceus WiKim85, P. pentosaceus WiKim86, and L. plantarum WiKim87, as identified by 16S rRNA gene sequence analysis; they were confirmed to be nonhemolytic and not able to produce β-glucuronidase, a carcinogenic enzyme. Probiotic properties of the five LAB strains were evaluated relative to those of commercial Lactobacillus rhamnosus GG, and results revealed probiotic potential of three strains (L. plantarum WiKim83, L. plantarum WiKim84, and L. plantarum WiKim87) to be superior. L. plantarum WiKim84 showed high antimicrobial activity against pathogens, and L. plantarum WiKim83 exhibited the highest antioxidant and β-galactosidase activities. Based on the probiotic and functional properties, the main characteristics of each strain were highlighted and two of them, L. plantarum WiKim83 and L. plantarum WiKim87, were selected as the most potent by principal component analysis. These strains showed antimicrobial, β-galactosidase, and antioxidant activities, which recommend their suitability as starter culture in various fermented foods.

Prophylactic Probiotics in Burn Patients: Risk versus Reward

Probiotics are often used in critically ill patients to prevent antibiotic-associated complications, including Clostridium difficile colitis. However, clinical evidence of their efficacy is lacking. The objective of this study is to assess the impact of prophylactic probiotic administration on bowel function, gut microbial diversity, and nutritional markers in adult burn patients. A retrospective cohort study was done on 108 burn patients aged 18 to 89. Patients were given >1 million colony-forming units per day of Lactobacillus acidophilus and Lactobacillus rhamnosus. Testing for C. difficile was used as a surrogate marker for the presence of diarrhea. Serum C-reactive protein and prealbumin values were measured. Additionally, the gut microbial diversity of eight patients was tracked via 16S quantitative PCR before and throughout the course of a standard probiotic regimen. Patients receiving oral probiotics had more reported diarrhea in the first and second weeks of treatment. In the second week, C-reactive protein levels were increased, while serum prealbumin levels were lower in patients receiving probiotics, suggesting potential malabsorption. Additionally, there was no difference in C. difficile infection, sepsis rates, emesis, or gastric residuals, indicating an absence of therapeutic benefit for probiotic administration in burn patients. Furthermore, it was determined that no discernible benefit to gut microbial diversity was conferred by probiotic therapy. Prophylactic probiotics in burn patients are not associated with improvements in patient outcomes and may in fact be associated with an increased incidence of diarrhea and malabsorption. Additional research is needed before routine use in burn patients.

The influence of organizational culture and job design on job commitment and human resource performance

Purpose

The purpose of this paper is to analyze the relationship between Job Design, Job Commitment and Organizational Culture with Human Resource Performance: a study of the construction services provided by national consultants.

Design/methodology/approach

The research population consisted of all employees of a national company offering consultation services, from four big Indonesian State-Owned Enterprises Contractors: PT. Yodya Karya Company, PT. Hutama Karya, PT. Adhy Karya, PT. Waskita Karya Referring to the approach to SEM modeling with an average population of 600 employees for each enterprises, the sample to be used as respondents consisted of 100 employees for each enterprises, and total 100×4 enterprises=400 samples.

Findings

The variables Organizational Culture and Job Design have a significant direct effect on Job Commitment. Likewise, the effect of Organizational Culture and Job Commitment on Human Resource Performance is also significant. However, a different result is shown in the result of the direct effect of the variable Job Design on the variable Human Resource Performance, which indicates that the variable Job Design does not have a significant direct effect on the variable Human Resource Performance. In other words, the intensity of the Job Design value will not affect the intensity level of Human Resource Performance. In addition, a mediating effect of the variable Job Commitment is found on the effect of Job Design and Organizational Culture on Human Resource Performance.

Originality/value

The use of Job Commitment to exercise a mediation effect on the relationship between the effect of Job Design and Organizational Culture on Human Resource Performance, and the research site (no previous research investigating this relationship).

Antagonistic Activities and Probiotic Potential of Lactic Acid Bacteria Derived From a Plant-Based Fermented Food

In this study, antagonistic activities and probiotic potential of lactic acid bacteria (LAB) derived from a plant-based fermented food, kimchi, were demonstrated. The cell free supernatants (CFS) from Lactobacillus curvatus KCCM 43119, Leuconostoc mesenteroides KCCM 43060, Weissella cibaria KCTC 3746, and W. koreensis KCCM 41517 completely inhibited the growth of foodborne pathogenic bacteria, while neutralized CFS (pH 6.5) partially inhibited the growth. The competition, exclusion, and displacement of foodborne pathogenic bacteria by the LAB strains from adhesion to HT-29 cells were investigated. The LAB strains were able to compete with, exclude, and displace the foodborne pathogenic bacteria. However, the degree of inhibition due to the adhesion was found to be a LAB strain-dependent phenomenon. The LAB strains showed high coaggregation with foodborne pathogenic bacteria, and they also exhibited high resistance to acidic condition. Except W. cibaria KCTC 3746, all LAB strains were capable of surviving in the presence of bile salts. Furthermore, while all LAB strains were resistant to chloramphenicol, kanamycin, streptomycin, gentamicin, and erythromycin, only W. cibaria KCTC 3746 and W. koreensis KCCM 41517 displayed resistance to vancomycin. These results suggest that the LAB strains derived from kimchi exerted antagonistic activities against foodborne pathogenic bacteria with probiotic potential.

Feasibility of a Lactobacillus casei Drink in the Intensive Care Unit for Prevention of Antibiotic Associated Diarrhea and Clostridium difficile

Background: Over 70% of patients are prescribed antibiotics during their intensive care (ICU) admission. The gut microbiome is dramatically altered early in an ICU stay, increasing the risk for antibiotic associated diarrhea (AAD) and Clostridium difficile infections (CDI). Evidence suggests that some probiotics are effective in the primary prevention of AAD and CDI. Aim: To demonstrate safety and feasibility of a probiotic drink in ICU patients. Methods: ICU patients initiated on antibiotics were recruited, and matched with contemporary controls. Study patients received two bottles daily of a drink containing 10 billion Lactobacillus casei which was bolused via feeding tube. Tolerance to probiotics and enteral nutrition, development of adverse events, and incidence of AAD was recorded. CDI rates were followed for 30 days post antibiotic treatment. Results: Thirty-two patients participated in the trial. There were no serious adverse events in the probiotic group, compared to three in the control group. AAD was documented in 12.5% of the probiotic group and 31.3% in the control group. One patient in the probiotic group developed CDI compared to three in the control group. Discussion: A probiotic containing drink can safely be delivered via feeding tube and should be considered as a preventative measure for AAD and CDI in ICU.

Sporulated Bacillus as alternative treatment for diarrhea of hospitalized adult patients under enteral nutrition: A pilot randomized controlled study

BACKGROUND & AIMS

Among hospitalized patients receiving enteral nutrition (EN), malnutrition and antibiotic use are some of the most common causes of diarrhea. Prebiotics and probiotics agents have been used for treatment of diarrhea in such patients. The aim of this study was to assess the efficacy of a sporulated Bacillus strain (Bacillus cereus A 05), compared to a control group using a prebiotic (soluble fiber), in reducing diarrhea in patients receiving EN and antibiotic therapy.

METHODS

Patients with diarrhea receiving EN were randomized to receive either B. cereus (study group) or soluble fiber (control group) for five days. The group treated with B. cereus received 4 vials with 5 mL × 10⁶ every 6 h. The control group treated with fiber received 10 g of soluble fiber every 8 h. Data assessed were serum albumin, nutrition status through Subjective Global Assessment (SGA), antibiotic use and osmolality (normal or hyperosmolar) of the tube feeding diets.

RESULTS

Twenty-nine patients were treated in each group. There was no significant difference between the groups regarding age, serum albumin, SGA score, dietary osmolality and antibiotic use. There was no significant difference between groups in ceasing diarrhea. However, the group treated with B. cereus took fewer days to cease diarrhea (2.5 ± 1.3 versus 3.7 ± 1.1 days, p = 0.011). Specifically, in the group treated with B. cereus A 05, malnourished patients did better than non-malnourished patients regarding diarrhea cessation (100% versus 25%, p < 0.001).

CONCLUSIONS

B. cereus A 05 was more effective than fiber in reducing diarrhea among patients under EN and antibiotic therapy and was more effective among malnourished patients.

The Shift of an Intestinal "Microbiome" to a "Pathobiome" Governs the Course and Outcome of Sepsis Following Surgical Injury

Sepsis following surgical injury remains a growing and worrisome problem following both emergent and elective surgery. Although early resuscitation efforts and prompt antibiotic therapy have improved outcomes in the first 24 to 48  h, late onset sepsis is now the most common cause of death in modern intensive care units. This time shift may be, in part, a result of prolonged exposure of the host to the stressors of critical illness which, over time, erode the health promoting intestinal microbiota and allow for virulent pathogens to predominate. Colonizing pathogens can then subvert the immune system and contribute to the deterioration of the host response. Here, we posit that novel approaches integrating the molecular, ecological, and evolutionary dynamics of the evolving gut microbiome/pathobiome during critical illness are needed to understand and prevent the late onset sepsis that develops following prolonged critical illness.

An update on probiotics, prebiotics and symbiotics in clinical nutrition

The concept of prebiotics, probiotics, and symbiotics and their use in different situations of daily clinical practice related to clinical nutrition is reviewed, as well as their role in the treatment/prevention of diarrhea (acute, induced by antibiotics, secondary to radiotherapy), inflammatory bowel disease (ulcerative colitis and pouchitis), in colonic health (constipation, irritable bowel), in liver disease (steatosis and minimum encephalopathy), and in intensive care, surgical, and liver transplantation. While their effectiveness for preventing antibiotic-induced diarrhea and pouchitis in ulcerative colitis appears to be shown, additional studies are needed to establish recommendations in most clinical settings. The risk of infection associated to use of probiotics is relatively low; however, there are selected groups of patients in whom they should be used with caution (as jejunum infusion).

Antibacterial activities of lactic acid bacteria isolated from cow faeces against potential enteric pathogens

BACKGROUND

The addition of sub therapeutic doses of antibiotics to cattle feed for growth promotion is a contributory factor to antibiotic resistance, thus an alternative to antibiotics is needed in animal feed additives.

OBJECTIVE

To determine the antimicrobial activity of cow's intestinal Lactic acid bacteria (LAB) against enteric commensals.

METHOD

Escherichia coli, Klebsiella species (spp) and LAB were isolated from thirty different cow faecal samples and the LAB identified by partial sequencing of 16S rRNA. The antimicrobial activity of the LAB was determined against the test Escherichia coli and Klebsiella spp.

RESULTS

Five species of LAB were isolated from thirty cow faecal samples and identified as Enterococcus hirae (8), Enterococcus durans (6), Enterococcus faecium (1), Enterococcus faecalis (1) and Weissella confusa (1). Viable cells and cell free supernatant (CFS) of the LAB were able to inhibit the growth of the test organisms with the largest zone of inhibition by the viable cells being 26mm against Escherichia coli CB6 produced by Enterococcus hirae CO6A while Weissella confusa CO29M and Enterococcus hirae CO2A produced the largest zones of inhibition (26mm) against Klebsiella CB2.

CONCLUSION

This study shows that LAB from cow faeces possess considerable antimicrobial activity against resistant Escherichia coli from the same environment.

Probiotic features of Lactobacillus strains isolated from Ragusano and Pecorino Siciliano cheeses

In the present study 177 Lactobacillus spp. strains, isolated from Ragusano and Pecorino Siciliano cheeses, were in vitro screened for probiotic traits, and their characteristics were compared to those of Lactobacillus rhamnosus GG, commercial strain. Based on acidic and bile salt resistance, thirteen Lactobacillus strains were selected. The multiplex-PCR application revealed that nine strains belonged to L. rhamnosus species and four to Lactobacillus paracasei species. All selected strains were further investigated for transit tolerance in simulated upper gastrointestinal tract (GI), for adhesion capacity to human intestinal cell lines, for hydrophobicity, for co-aggregation and auto-aggregation and for antimicrobial activities. Moreover, antibiotic resistance, hemolytic and bile salt hydrolase activities were investigated for safety assessment. Viable counts after simulated gastric and duodenal transit revealed that overall the selected lactobacilli tolerated better pancreatic juice and bile salts than acidic juice. In particular, three L. rhamnosus strains (FS10, FS2, and PS11) and one L. paracasei strain (PM8) increased their cell density after the simulated GI transit. The same strains showed also high percentage of auto-aggregation and co-aggregation with Escherichia coli. All strains were effective against both Staphylococcus aureus and E. coli and variability was achieved versus Listeria monocytogenes and Enterococcus faecalis used as pathogenic indicator strains. Different behavior was revealed by strains for adhesion ability and hydrophobicity, which are not always linked each other and are strongly strain-dependent. From the safety point of view, no isolate showed hemolytic and bile salt hydrolase activities, except one, and most of the strains were sensitive to a broad range of clinical antibiotics. This work showed that the L. rhamnosus FS10 and the L. paracasei PM8 are good promising probiotic candidates for further in vivo investigations.

Antibiotic-associated diarrhea: a refresher on causes and possible prevention with probiotics--continuing education article

Antibiotic-associated diarrhea (AAD) describes any unexplained diarrhea associated with the use of an antibiotic. AAD also includes infection caused by Clostridium difficile, however this organism only accounts for a small percentage of diarrhea caused by antibiotics. AAD can be caused by multiple other organisms including C perfringens, S aureus, and Candida. Some antibiotics are more likely to cause non-C difficile AAD, such as erythromycin and the penicillin class. AAD develops through the loss of normal flora and reduced colonic bacterial carbohydrate metabolism during antibiotic administration. There is an increasing interest in the use of probiotics for the prevention of AAD. There are several meta-analyses that report a relative risk reduction of AAD with the use of probiotics during antibiotic administration. Interpretation of these studies has been challenging due to the heterogeneity and size of the patient populations, unclear probiotic regimen, and unclear safety profile. Since AAD can be a reason for a patient to become non-compliant or receive incomplete treatment, clinicians should monitor for this potential adverse effect caused by antibiotics.

Bugs or drugs: are probiotics safe for use in the critically ill?

Probiotics are living microorganisms which have demonstrated many benefits in prevention, mitigation, and treatment of various disease states in critically ill populations. These diseases include antibiotic-associated diarrhea, Clostridium difficile diarrhea, ventilator-associated pneumonia, clearance of vancomycin-resistant enterococci from the GI tract, pancreatitis, liver transplant, major abdominal surgery, and trauma. However, their use has been severely limited due to a variety of factors including a general naïveté within the physician community, lack of regulation, and safety concerns. This article focuses on uses for probiotics in prevention and treatment, addresses current concerns regarding their use as well as proposing a protocol for safe use of probiotics in the critically ill patient.

Diarrhea in enterally fed patients: blame the diet?

PURPOSE OF REVIEW

Diarrhea has great impact on enteral nutrition. The purpose of this review is to identify the factors leading to diarrhea during enteral nutrition and to provide the published updates on diarrhea prevention through nutritional intervention.

RECENT FINDINGS

Diarrhea in enteral fed patients is attributed to multiple factors, including medications (major contributor), infections, bacterial contamination, underlying disease, and enteral feeding. Diet management can alleviate diarrhea in enteral feeding. High content of fermentable oligosaccharides, disaccharides, and monosaccharides and polyols (FODMAPs) in enteral formula is postulated to induce diarrhea and lower FODMAPs formula may reduce the likelihood of diarrhea in enterally fed patients. Fiber-enriched formula can reduce the incidence of diarrhea and produce short-chain fatty acids for colonocytes. Ingesting prebiotics, nonviable probiotics or probiotic derivatives, and human lactoferrin may provide alternatives for reducing/preventing diarrhea.

SUMMARY

Enteral feeding is not generally considered the primary cause of diarrhea, which is frequently linked to prescribed medications. When diarrhea is apparent, healthcare members should evaluate the possible risk factors and systematically attempt to eliminate the underlying causes of diarrhea before reducing or suspending enteral feeding. Lower FODMAPs formula, prebiotics, probiotic derivatives, and lactoferrin may be used to manage enteral feeding-related diarrhea.

Postbiotics: what else?

The use of probiotics and synbiotics in the food industry or as food supplements for a balanced diet and improved gut homeostasis has been blooming for the past decade. As feedback from healthy consumers is rather enthusiastic, a lot of effort is currently directed in elucidating the mechanisms of interaction between beneficial microbes and barrier and immune function of the host. The use of probiotics or synbiotics for treating certain pathologies has also been examined, however, the outcome has not always been favourable. In most cases, the effect of the administered probiotic is evident when the bacteria are still alive at the time they reach the small and large intestine, suggesting that it is dependent on the metabolic activity of the bacteria. Indeed, in some occasions it has been shown that the culture supernatant of these bacteria mediates the immunomodulatory effect conferred to the host. Recent work on relevant probiotic strains has also led to the isolation and characterisation of certain probiotic-produced, soluble factors, here called postbiotics, which were sufficient to elicit the desired response. Here, we summarise these recent findings and propose the use of purified and well characterised postbiotic components as a safer alternative for clinical applications, especially in chronic inflammatory conditions like inflammatory bowel disease, where probiotics have not yet given encouraging results as far as induction of remission is concerned.

Microbiota of table olive fermentations and criteria of selection for their use as starters

Fermentation is one of the oldest methods for preserving of olives applied worldwide for thousands of years. However, olive processing is a speculative area where whether olives are fermented products or pickled products produced by organic acids and salt. Although lactobacilli and yeasts play a major role in the process, literature survey indicates that lactobacilli are less relevant at least in some types of natural green olives during fermentation. There have been significant advances recently in understanding the process to produce olives, especially the role of lactic acid bacteria and yeasts including biofilm formation on olive surfaces by these organisms. The purpose of this paper is to review the latest developments regarding the microbiota of olives on the basis of olive types, their role on the fermentation process, the interaction between both group of microorganisms and the olive surface, the possibility to use starter cultures and the criteria to select appropriate cultures.