Probiotic bacterial application in pediatric critical illness as coadjuvants of therapy

Christian Zanza, Tatsiana Romenskaya, Yaroslava Longhitano, Fabio Piccolella, Fabrizio Racca, Michele Fidel Tassi, Francesca Rubulotta, Ludovico Abenavoli, Dana Shiffer, Francesco Franceschi, Alessio Migneco, Angela Saviano, Andrea Piccioni, Veronica Ojetti

Research output: Contribution to journalReview articlepeer-review


The use of probiotics in critically ill adult and children patients has been growing exponen-tially over the last 20 years. Numerous factors in pediatriac intensive care unit (PICU) patients may contribute to intestinal dysbiosis, which subsequently promotes the pathobiota’s growth. Currently, lactobacillus and bifidobacterium species are mainly used to prevent the development of systemic diseases due to the subverted microbiome, followed by streptococcus, enterococcus, propionibacterium, bacillus and Escherichia coli, Lactobacillus rhamnosus GG, and Lactobacillus reuteri DSM 17938. The aim of this article is to review the scientific literature for further confirmation of the importance of the usage of probiotics in intensive care unit (ICU) patients, especially in the pediatric population. A progressive increase in nosocomial infections, especially nosocomial bloodstream infections, has been observed over the last 30 years. The World Health Organization (WHO) reported that the incidence of nosocomial infections in PICUs was still high and ranged between 5% and 10%. Petrof et al. was one of the first to demonstrate the efficacy of probiotics for preventing systemic diseases in ICU patients. Recently, however, the use of probiotics with different lactobacillus spp. has been shown to cause a decrease of pro-inflammatory cytokines and an increase in anti-inflammatory cytokines. In addition, in some studies, the use of probiotics, in particular the mix of Lactobacillus and Bifidobac-terium reduces the incidence of ventilator-associated pneumonia (VAP) in PICU patients requiring mechanical ventilation. In abdominal infections, there is no doubt at all about the usefulness of using Lactobacillus spp probiotics, which help to treat ICU-acquired diarrhoea episodes as well as in positive blood culture for candida spp. Despite the importance of using probiotics being supported by various studies, their use is not yet part of the standard protocols to which all doctors must adhere. In the meantime, while waiting for protocols to be drawn up as soon as possible for use in PICUs, routine use could certainly stimulate the intestine’s immune defences. Though it is still too early to say, they could be considered the drugs of the future.

Original languageEnglish
Article number781
JournalMedicina (Lithuania)
Issue number8
Publication statusPublished - Aug 2021


  • Children
  • Lactobacillus
  • Lactobacillus reuteri
  • Pediatric critical illness
  • Pediatric intensive care unit
  • Probiotic

ASJC Scopus subject areas

  • Medicine(all)


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