Probiotics Prevent Surgical Site Infections in Patients With CRC

Surgical site infections (SSIs) were prevented in patients with colorectal cancer (CRC) through the distribution of probiotics prior to their operations, according to a review published in International Wound Journal. Multistrain probiotics were more effective compared with those with single-strain efficacy.

CRC has increased over the years, with surgical resection the most common treatment for the cancer. However, SSIs pose a risk for all patients who undergo this operation. Antibiotics are often used to treat SSIs but antibiotic resistance and several adverse effects have proved to be challenges in treating patients. This meta-analysis aimed to evaluate how effective probiotics were in reducing SSIs in patients having a resection and evaluate their safety profile and if different strains or combinations of probiotics are more effective.

The study researchers searched PubMed, Embase, Web of Science, and Cochrane Library on September 19, 2023, to look for studies to include in this review. Studies were included if the populations were patients with CRC given probiotics in the perioperative stage, had data on SSI rates, if probiotics were given orally, or had more extensive data on a similar cohort. Studies were excluded if they focused on patients receiving chemotherapy, if the manuscript had incomplete or inconclusive data, were suboptimal quality, or were case reports, editorial commentaries, expert opinions, or narrative reviews. Data from the studies included country, sample size, age range, type of intervention, and duration of intervention.

There were 10 studies included in the meta-analysis that were published between 2011 and 2016. The studies came from China, Japan, Malaysia, Greece, Sweden, and Brazil. The duration of the intervention ranged from 3 to 28 days. Most studies used Lactobacillus and Bifidobacterium species as their probiotic. Twenty percent of the studies included had a high risk of bias.

A lower incidence of SSIs were found in patients with CRC who were administered probiotics compared with the control group who weren’t (OR, 0.45; 95% CI, 0.28-0.72). Patients who were given probiotics also had shorter hospital stay compared with the control group (weighted mean difference, –1.29 days; 95% CI, –2.27 to –0.32). Patients who took a single-strain probiotic did not have enough statistical evidence to conclude that infections were reduced (OR, 0.49; 95% CI, 0.22-1.07), but data did suggest there was a decrease in infections when multiple probiotic strains were used (OR, 0.36; 95% CI, 0.22-0.50).

There were some limitations to this study. There was variability in the strains and doses of probiotics in the studies, which could have led to confounding factors, and there was a lack of standardized reporting and outcome measures in the studies that were included. Further, efficacy of the probiotic could have been affected by the dietary, cultural, and genetic differences between the countries.

Using probiotics prior to a resection in patients with CRC has proven to be effective in preventing SSIs in this population. Multistrain probiotics were also found to be more effective compared with single-strain probiotics.

Reference

Chen J, Zhao J, Wu H, Wang T, Gao C. Efficacy and safety of oral probiotic supplementation in mitigating postoperative surgical site infections in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Int Wound J. Published online December 28, 2023. doi:10.1111/iwj.14603