The role of probiotics in the prevention of severe infections following abdominal surgery

Abstract

Administration of probiotics has been proposed for various medical and surgical conditions. Their effect has been largely attributed to their ability to maintain the integrity of the intestinal mucosal barrier as well as to modulate the innate immune response. Multiple studies have demonstrated their effect in reducing infectious complications in critically ill patients, minimising bacterial translocation and increasing the secretion of anti-inflammatory cytokines. Furthermore, they have been shown to be effective in reducing infections following colorectal surgery, while at the same time preventing overgrowth of bacterial species such as Pseudomonas aeruginosa that has been implicated in the pathogenesis of anastomotic leak. Recent experimental studies have demonstrated that probiotics may decrease expression of the SOCS3 gene, which encodes the protein SOCS3 that suppresses cytokine production, implying a direct interaction of probiotics with the innate immune system. These results hold high promises for the development of new therapeutic strategies.

Introduction

The use of probiotics, which are live microbial supplements exerting beneficial effects on the host by restoring the gastrointestinal flora, has been proposed for a variety of medical and surgical conditions. Whilst much of the work involving probiotics has focused on the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection, their application for modulating the intestinal microbiome with profound benefit on the function of the gut mucosal barrier and the innate immune response of the host, leading to the prevention of infections, appears to be another novel, highly promising alternative strategy.