Efficacy of probiotics in vancomycin-resistant enterococci decolonization: A meta-analysis of randomized clinical trials.

In 30 seconds

This meta-analysis of randomized clinical trials assessed probiotics for vancomycin-resistant enterococci (VRE) decolonization, including subgroup analyses by treatment duration, strain, and age. Five trials involving 189 patients (95 receiving probiotics and 94 controls) were included. Overall, probiotics were associated with lower VRE colonization than control treatments (OR: 5.70, 95% CI: 1.29-25.07, I 2 = 68%, p = 0.02), although the authors noted small samples, wide confidence intervals, and heterogeneity. Subgroup results suggested benefit with Lactobacillus rhamnosus GG and in pediatric patients, but not in adults or with Lcr35.

Key findings

• Across five trials, probiotics statistically decreased VRE colonization versus control (OR: 5.70, 95% CI: 1.29-25.07, I 2 = 68%, p = 0.02).
• Lactobacillus rhamnosus GG was associated with reduced VRE colonization (OR: 7.22, 95% CI: 1.34-39.02, I 2 = 76%, p = 0.02); Lcr35 was not.
• In pediatric patients, probiotics statistically decreased VRE colonization (OR: 7.17, 95% CI: 2.37-21.71, I 2 = 11%, p = 0.0005); the adult subgroup result was not significant.

Why it matters

VRE colonization is a clinically relevant target, and this synthesis suggests probiotics may help reduce it, with the clearest subgroup signals for pediatric patients and LGG. However, the overall evidence is based on few patients and heterogeneous studies, so the findings are better viewed as a basis for further evaluation than as definitive evidence of effectiveness.

What to keep in mind

Only five trials and 189 patients were included; the overall estimate had wide confidence intervals and substantial heterogeneity. Subgroup estimates were also imprecise.