英国南安普顿大学Nick A. Francis联合牛津大学Christopher C. Butler团队研究了使用益生菌对疗养院居民抗生素使用的影响。相关论文于2020年7月7日发表在《美国医学会杂志》上。
益生菌是居民在疗养院中经常使用的药物，虽然在这些情况下，益生菌是否能预防感染并减少抗生素使用的证据很有限。
为了确定每日口服鼠李糖乳杆菌GG和动物双歧杆菌乳酸亚种BB-12的益生菌组合与安慰剂相比是否能减少疗养院居民的抗生素使用，2016年12月至2018年5月，研究组进行了一项安慰剂对照的随机临床试验，在英国的23个疗养院招募了310名65岁及以上的养老院居民，最后随访于2018年10月31日。将参与者随机分组，其中155例每日接受含有鼠李糖乳杆菌GG和动物双歧杆菌乳酸亚种BB-12的益生菌组合胶囊，155例接受安慰剂治疗，为期1年。
310名疗养院参与者的平均年龄为85.3岁，女性占66.8％，195人（62.9％）存活并完成了试验。益生菌组中有98.7%的参与者每日数据（包括研究产品使用情况、抗生素施用和感染迹象）详尽，安慰剂组中有97.4%。益生菌组的参与者全身性抗生素平均施用天数为12.9天，而安慰剂组为12.0天。共有120位疗养院居民经历了283次不良事件（益生菌组为150次，安慰剂组为133次）。益生菌组中住院94起，安慰剂组为78起；益生菌组中死亡33例，安慰剂组中死亡32例。
总之，对于疗养院居民来说，每天服用鼠李糖乳杆菌GG和动物双歧杆菌乳亚种BB-12的益生菌组合并不能显著降低全因感染的抗生素使用。
附：英文原文
Title: Effect of Probiotic Use on Antibiotic Administration Among Care Home Residents: A Randomized Clinical Trial
Author: Christopher C. Butler, Mandy Lau, David Gillespie, Eleri Owen-Jones, Mark Lown, Mandy Wootton, Philip C. Calder, Antony J. Bayer, Michael Moore, Paul Little, Jane Davies, Alison Edwards, Victoria Shepherd, Kerenza Hood, F. D. Richard Hobbs, Mina Davoudianfar, Heather Rutter, Helen Stanton, Rachel Lowe, Richard Fuller, Nick A. Francis
Issue&Volume: 2020/07/07
Abstract:
Importance Probiotics are frequently used by residents in care homes (residential homes or nursing homes that provide residents with 24-hour support for personal care or nursing care), although the evidence on whether probiotics prevent infections and reduce antibiotic use in these settings is limited.
Objective To determine whether a daily oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 compared with placebo reduces antibiotic administration in care home residents.
Design, Setting, and Participants Placebo-controlled randomized clinical trial of 310 care home residents, aged 65 years and older, recruited from 23 care homes in the United Kingdom between December 2016 and May 2018, with last follow-up on October 31, 2018.
Interventions Study participants were randomized to receive a daily capsule containing a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 (total cell count per capsule, 1.3×1010 to 1.6×1010) (n=155), or daily matched placebo (n=155), for up to 1 year.
Main Outcomes and Measures The primary outcome was cumulative antibiotic administration days for all-cause infections measured from randomization for up to 1 year.
Results Among 310 randomized care home residents (mean age, 85.3 years; 66.8% women), 195 (62.9%) remained alive and completed the trial. Participant diary data (daily data including study product use, antibiotic administration, and signs of infection) were available for 98.7% randomized to the probiotic group and 97.4% randomized to placebo. Care home residents randomized to the probiotic group had a mean of 12.9 cumulative systemic antibiotic administration days (95% CI, 0 to 18.05), and residents randomized to placebo had a mean of 12.0 days (95% CI, 0 to 16.95) (absolute difference, 0.9 days [95% CI, –3.25 to 5.05]; adjusted incidence rate ratio, 1.13 [95% CI, 0.79 to 1.63]; P=.50). A total of 120 care home residents experienced 283 adverse events (150 adverse events in the probiotic group and 133 in the placebo group). Hospitalizations accounted for 94 of the events in probiotic group and 78 events in the placebo group, and deaths accounted for 33 of the events in the probiotic group and 32 of the events in the placebo group.
Conclusions and Relevance Among care home residents in the United Kingdom, a daily dose of a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 did not significantly reduce antibiotic administration for all-cause infections. These findings do not support the use of probiotics in this setting.
DOI: 10.1001/jama.2020.8556
Source: https://jamanetwork.com/journals/jama/article-abstract/2767862
JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：157.335
官方网址：https://jamanetwork.com/
投稿链接：http://manuscripts.jama.com/cgi-bin/main.plex
本期文章：《美国医学会杂志》：Vol 324 No 1
