Mohammad Alomari, MD
Resident
Cleveland Clinic Foundation
Cleveland, Ohio
Mohammad Alomari, MD1, Laith Al Momani, MD2, Muhammad Talal Sarmini, MD1, Shrouq Khazaaleh, MD3, Shaden Almomani, MD4, Tyler Aasen, MD2, Mark Young, MD2
1Cleveland Clinic Foundation, Cleveland, OH; 2East Tennessee State University, Johnson City, TN; 3King Abdullah University Hospital, Ar Ramtha, Irbid, Jordan; 4Jordanian Royal Medical Services, Irbid, Irbid, Jordan
Introduction: Parenteral nutrition (PN) is a life-saving modality that carries risks for potentially life-threatening complications. The gut microbiome, which is often impaired in patients receiving PN, plays an integral role in intestinal wall integrity and immune function. Hence, restoration of a healthy microbiome may theoretically protect against various infections. Therefore, we aimed in our study to investigate the effect of probiotics on parenteral nutrition-related infectious complications.
Methods: We identified a cohort of patients with intestinal failure who received PN for >2 weeks at our center for human nutrition between January 2005 and August 2016. We excluded patients < 18 years of age, patients who used probiotics for < 30 days, and those who had long-term antibiotic use ( >30 days). Seventy-eight patient received probiotics, among them, 48% used it for small intestinal bacterial overgrowth (SIBO) treatment, 42% for SIBO prophylaxis in high-risk patients (history of recurrent SIBO, resection of the ileocecal valve, and surgically created blind loops), and 10% of the patients used non-prescription over-the-counter probiotics. Patients characteristics and other variables were determined by manual chart review.
Results: A total of 282 patients who received prolonged parenteral support were included. Eighty-five percent of our sample received PN, while the remaining received intravenous fluids (IVF). A total of 78 (27.7%) patients used probiotics. (Table 1) One hundred and six (37.6%) patients were diagnosed with SIBO, 31(11%) patients had at least one episode of catheter-related infection, and 88(31.2%) patients had at least one documented episode of sepsis. The prevalence of SIBO in patients who used prophylactic probiotic was 22 % vs. 30 % in patients who did not use probiotics, p = 0.5. Compared to non-users, the prevalence of sepsis and catheter-related infection among probiotics users were (26.9% vs. 32.8%; p=0.33 and 7.7% vs. 12.3%; p=0.27, respectively) (Figure1)
Discussion: Although there was a non-significant trend toward less SIBO, sepsis and catheter-related infections among patients using probiotics, our findings don’t support the routine use of probiotics to prevent or treat PN-related complications. Interestingly, this study revealed-despite the lack of evidence- a quarter of our included patients received a medical prescription for probiotics to prevent or treat SIBO.
Citation: Mohammad Alomari, MD; Laith Al Momani, MD; Muhammad Talal Sarmini, MD; Shrouq Khazaaleh, MD; Shaden Almomani, MD; Tyler Aasen, MD; Mark Young, MD. P1701 - THE EFFECTS OF PROBIOTICS ON PARENTERAL NUTRITION-RELATED COMPLICATIONS: A PRESCRIBER’S DILEMMA. Program No. P1701. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.