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DOI: 10.1055/s-2002-35259
Einfluss von Probiotika und Ballaststoffen auf die Inzidenz bakterieller Infektionen nach viszeralchirurgischen Eingriffen - Ergebnisse einer prospektiven Studie
Influence of Probiotics and Fibre on the Incidence of Bacterial Infections Following Major Abdominal Surgery - Results of a Prospective TrialPublikationsverlauf
Manusscript received: 1 March 2002
Accepted after revision: 23 June 2002
Publikationsdatum:
18. November 2002 (online)
Zusammenfassung
Fragestellung: Frühe enterale Ernährung mit Ballaststoffen und Probiotika soll die bakterielle Translokation und damit die Inzidenz bakterieller Infektionen nach viszeralchirurgischen Operationen vermindern.
Methoden: In einer prospektiv randomisierten Studie mit insgesamt 172 Patienten nach großen viszeralchirurgischen Eingriffen verglichen wir die Inzidenz postoperativer Infektionen unter a) konventioneller parenteraler oder enteraler Ernährung, b) früher enteraler Ernährung mit Ballaststoffen und Laktobazillus plantarum 299 oder c) enteraler Ernährung und hitzeinaktiviertem Laktobazillus (Plazebo). Nach Lebertransplantation wurde außerdem selektive Darmdekontamination (SDD) verabreicht. Routinelaborparameter, ernährungsspezifische Parameter und der zelluläre Immunstatus im peripheren Blut wurden präoperativ und an den postoperativen Tagen 1, 5 und 10 gemessen.
Ergebnisse: Die Gruppen waren vergleichbar hinsichtlich präoperativer ASA-Klassifikation, Child-Pugh-Klassifikation der Zirrhose, operativer Daten und Immunsuppression. Die Inzidenz postoperativer bakterieller Infektionen nach Magen-, Leber- oder Pankreasresektion betrug 31 % in der konventionellen Gruppe a), 4 % in der Laktobazillen-Gruppe b) und 13 % in der Plazebo-Gruppe c). Der Unterschied zwischen Gruppe a) und b) war statistisch signifikant. In der Analyse von 95 Patienten nach Lebertransplantation traten ebenfalls signifikant weniger Infektionen in der Laktobazillen-Gruppe auf (13 %) als in der konventionellen SDD-Gruppe (48 %), die Rate in der Plazebo-Gruppe lag bei 34 %. Cholangitis und Pneumonie waren die häufigsten Infektionen; meist wurden Enterokokken isoliert. In der Gruppe mit Laktobazillen war auch die mittlere Dauer der Antibiotikatherapie kürzer als in den anderen Gruppen. Ballaststoffe und Laktobazillen wurden gut toleriert
Schlussfolgerung: Frühe enterale Ernährung mit Zusatz von Ballaststoffen und Probiotika führte zu einer Senkung der Inzidenz von bakteriellen Infektionen nach abdominalchirurgischen Eingriffen und Lebertransplantation im Vergleich zu konventioneller Ernährung mit und ohne SDD. Durch Verkürzung der Antibiotikatherapie sowie Einsparung von SDD können Kosten reduziert werden.
Abstract
Introduction: Early enteral nutrition with fibre and probiotics has been effective in preventing bacterial translocation and is therefore expected to reduce the incidence of postoperative bacterial infections.
Patients and methods: In a prospective randomized trial including 172 patients following major abdominal surgery or liver transplantation, the incidence of bacterial infections was compared in patients receiving either a) conventional parenteral or enteral nutrition, b) enteral nutrition with fibre and lactobacillus plantarum 299 or c) enteral nutrition with fibre and heat inactivated lactobacilli (placebo). Liver transplant recipients were also treated with selective bowel decontamination (SBD). Routine laboratory parameters, nutritional parameters and the cellular immune status were measured preoperatively and on postoperative days 1, 5 and 10.
Results: Patients were comparable regarding preoperative ASA-classification, Child-Pugh classification of cirrhosis, operative data and immunosuppression. The incidence of bacterial infections after liver, gastric oder pancreas resection was 31 % in the conventional group a) compared to 4 % in the lactobacillus-group b) and 13 % in the placebo-group c). In the analysis of 95 liver transplant recipients, 13 % group b)-patients developed infections compared to 48 % group a)-patients and 34 % group c)-patients. The difference between groups a) and b) was statistically significant in both cases. In addition, the duration of antibiotic therapy was significantly shorter in the lactobacillus-group. Cholangitis and pneumonia were the most frequent infections and enterococci the most frequently isolated bacteria. Fibre and lactobacilli were well tolerated in most cases.
Conclusion: Fibre and probiotics could lower the incidence of bacterial infections following major abdominal surgery in comparison to conventional nutrition with or without SBD. With this new concept, costs can be reduced by shortening the duration of antibiotic therapy and sparing SBD.
Schlüsselwörter
enterale Ernährung - Probiotika - Ballaststoffe - Infektion - Lebertransplantation
Key words
Enteral nutrition - probiotics - dietary fibres - infection - liver transplantation
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Frau Dr. Nada Rayes
Klinik für Allgemein-, Viszeral- und
Transplantationschirurgie, Charité Campus
Virchow, Augustenburger Platz l
13355 Berlin, Germany
Telefon: 030/450-552002
Fax: 030/450-552900
eMail: nada.rayes@charite.de