Synbiotics for prevention of ventilator-associated pneumonia: a probiotics strain-specific network meta-analysis.

Objective: Probiotics may be efficacious in preventing ventilator-associated pneumonia (VAP). The aim of this network meta-analysis (NMA) was to clarify the efficacy of different types of probiotics for preventing VAP.

Methods: This systematic review and NMA was conducted according to the updated preferred reporting items for systematic review and meta-analysis. A systematic literature search of public databases from inception to 17 June 2018 was performed.

Results: NMA showed that “ +  + ” was more efficacious than “” in preventing VAP (odds ratio: 0.15, 95% confidence interval: 0.03–0.94). According to pairwise meta-analysis, “ +  + ” and “” were superior to placebo in preventing VAP. Treatment rank based on surface under the cumulative ranking curves revealed that the most efficacious treatment for preventing VAP was “ +  + ” (66%). In terms of reducing hospital mortality and ICU mortality, the most efficacious treatment was Synbiotic 2000FORTE (34% and 46%, respectively).

Conclusions: Based on efficacy ranking, “ +  + ” should be the first choice for prevention of VAP, while Synbiotic 2000FORTE has the potential to reduce in-hospital mortality and ICU mortality.