Good Bugs Fight Bad Bugs in the ICU

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The care of the critically ill is full of Catch-22s. Mechanical ventilators deliver life-saving oxygen to failing lungs. But the same intubation introduces bacteria to cause ventilator-associate pneumonia. Worse, in a hospital setting, those bacteria often include some of the world's nastiest, drug-resistant pathogens. In an effort to beat back this threat, nurses wash out patients' mouths with the potent antiseptic chlorhexidine. But that, in turn, tends to ipe out all the patient's mouth bacteria--both good and bad--opening up territory for more drug-resistant hospital bugs to move in. Even scarier hospital, strains of methicillin resistant Staphylococcus aureus (MRSA) are proving increasing resistant to this disinfectant

Now, in the spirit of "if you can't beat 'em ...," doctors at Sweden's Lund University Hospital are deliberately inoculating their patients with "good germs." Specifically, anesthesiologist Bengt Klarin and colleagues are swabbing the mouths of critically ill, intubated patients with a well-studied strain of Lactobacillus plantarum--a normal resident of healthy mouths and the active ingredient in sauerkraut and many other fermented foods.

The probiotic bacteria prevented infection as well as did standard disinfection with chlorhexidine. Using L. plantarum also avoided such common chlorhexidine side effects as mouth irritation and potentially deadly allergic reactions the researchers report.

Here's the full report, in last month's issue of Critical Care. 

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