PROSPECT: Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial

Probiotics are commercially available live bacteria thought to have health benefits when ingested. Studies have shown that probiotics may prevent 25% of all pneumonias when patients are on a breathing machine, 18% of all other infections, and 65% of serious bowel infections. However, previous studies were small and potentially biased; therefore, whether probiotics are truly helpful remains unclear. We have completed a randomized controlled pilot trial in critically ill ventilated patients in 14 intensive care units (ICUs) to test the feasibility of doing a larger trial. We demonstrated that we can enroll patients, follow the protocol, and that infections in the ICU are common. We are proceeding to investigate whether L. rhamnosus GG (a common probiotic) given during critical illness prevents infection (pneumonia, bowel infection with Clostridium difficile, and other infections), as well as diarrhea and overutilization of antibiotics. We will enroll 2650 adults admitted to the ICU who need a breathing machine. Patients will receive either the probiotic or a placebo, twice daily given down a feeding tube into the stomach. This novel intervention is key to the ongoing search for more effective and inexpensive strategies to prevent serious infections in the ICU. Probiotics may be an easy-to-use, readily available, affordable approach to help future critically ill patients around the world.