Efficacy of probiotics in vancomycin-resistant enterococci decolonization: A meta-analysis of randomized clinical trials.

OBJECTIVE

This meta-analysis investigated whether probiotics can decolonize vancomycin-resistant enterococci (VRE) and examined the effects of probiotics through subgroup analyses stratified by treatment duration, probiotic strain, and patient age.

METHODS

We searched PubMed, Embase, and MEDLINE for human trials evaluating probiotics for VRE decolonization. The primary outcome was overall probiotic effectiveness in decolonizing VRE; subgroup analyses stratified by treatment duration (<12 vs. ≥12 weeks), probiotic strain (Lactobacillus rhamnosus GG [LGG] vs. non-LGG), and age group (<18 vs. ≥18 years) were also conducted. Odds ratios (ORs) with 95% confidence intervals (CIs) and p values were derived from a random-effects model using the Z test in Review Manager version 5.4.1.

RESULTS

Five trials involving 189 patients (95 probiotic, 94 control) were included. Probiotics statistically decreased VRE colonization compared with control treatments with small sample sizes, wide CIs, and heterogeneity across studies (OR: 5.70, 95% CI: 1.29-25.07, I2 = 68%, p = 0.02). Neither short-duration (OR: 4.26, 95% CI: 0.81-22.43, I2 = 70%, p = 0.09) nor long-duration (OR: 4.89, 95% CI: 0.27-89.78, I2 = 65%, p = 0.28) treatments were significantly effective. LGG statistically decreased colonized VRE (OR: 7.22, 95% CI: 1.34-39.02, I2 = 76%, p = 0.02) more than Lactobacillus rhamnosus Lcr35 (OR: 1.50, 95% CI: 0.06-40.63, I2 not applicable, p = 0.81). Probiotics statistically decreased colonized VRE in pediatric patients (OR: 7.17, 95% CI: 2.37-21.71, I2 = 11%, p = 0.0005) but not in adults (OR: 5.07, 95% CI: 0.24-105.69, I2 = 76%, p = 0.29).

CONCLUSIONS

Probiotics, particularly LGG, may facilitate decolonizing VRE from the human gut, especially in pediatric patients. Inconsistent effect was observed in adults or with Lactobacillus rhamnosus Lcr35.