Ahmad Tajehmiri^*1, Saeid Rahbar², Farhad Oubari¹

¹Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. ²Department of Microbiology, Faculty of Science, Lahijan Branch, Islamic Azad University, Lahijan, Iran.

DOI : https://dx.doi.org/10.13005/bpj/592

Abstract

Probiotics are usually defined as live microbial food ingredients beneficial to health which comprise of normal commensally bacteria as a part of the healthy human gut microflora. Different species of microorganisms such as lactic acid bacteria (Bifidobacteriumand Lactobacillusspp.) or yeasts have been proposed for human use.Nosocomial infections occur worldwide and affect both developed and poor countries.The most common organisms causing nosocomialinfection in neonates include Staphylococcus, Pseudomonas aeruginosa,Escherichiacoli,Klebsiella, and Candida.There is preliminary evidence that probiotic type microorganisms may control the growth of nosocomial pathogens.The aim of this review is to consider the current evidence on the effects of probiotics for control of nosocomial infections.

Keywords

Probiotics; nosocomial infections; safety; Infection control

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Introduction

Probiotics can be defined as nonpathogenic microorganisms that, when ingested, exert a positive influence on the health of the host. They consist of either yeast or bacteria, especially lactic acid bacteria. The most commonly used organisms in probiotic products belongs to Lactobacillus and Bifidobacterium spp., Other organisms have also been used including Bacillus spp., and yeast such as Saccharomyce boulardii (Darsanaki and Aliabadi, 2013). In Table 1 are listed some of the known probiotics available (Mombelli and Gismondo, 2000).

Table 1: Common Probiotics for Human Use

Lactobacillus species	Bifidobacterium species	Other bacteria	Non-lactic acid producing bacteria
L. acidophilus	B. lactis	L. lactis	S. cerevisiae
L. casei	B. animalis	E. faecium	B. subtilis
L. crispatus	B. bifidum	E. faecalis	S. boulardii
L. gasseri	B. infantis	P. acidilactici	B. cereus
L. johnsonii	B. adolescentis	–	–
L. reuteri	–	–	–
L. rhamnosus	–	–	–

 

Probiotics can produce inhibitory compounds such as lactic acid, bacteriocin, hydrogen peroxide, acetaldehyde anddiacetyl. These compounds are able to inhibit the growth of pathogenic microorganisms (Zapata, 2013). Probiotics could be used for several conditions such as Urinary Tract Infections, Irritable Bowel Syndrome, Immune Disorders, Lactose Intolerance, Hyper Cholesterolaemia, Inflammatory Bowel Disease,Cancer, Allergy andDiarrhea(Zerehpoosh and darsanaki, 2013). Nosocomial infections occur worldwide and affect both poor and developed countries. Infections acquired in health care settings are among the major causes of death and increased morbidity among hospitalized patients. They are a significant burden both for the patient and for public health (WHO, 2002). Over the past 50 years, the epidemiology of pathogens responsible for nosocomial infections in neonates has changed dramatically. During the 1950s, Staphylococcusaureus was the most common nosocomial pathogen in hospitalized infants. During the 1960s, gram-negative bacilli, including Pseudomonas aeruginosa, Klebsiella sp, and Escherichia coli, became the most common pathogens. By the 1970s, coagulasenegative staphylococci (CONS) (S. epidermidis) and S. aureus, including methicillinresistant S. aureus (MRSA), became the predominant causes of hospital-acquired infections in the neonatal intensive care unit. Today, gram-positive cocci continue to cause the largest proportion of infections, and many, including CONS,MRSA, and vancomycin-resistant enterococci(VRE), are multidrug-resistant. Gram-negative bacilli are responsible for 20% to 30% of cases of lateonset sepsis and 30% of nosocomial pneumonias (Table. 2) (Polin and Saiman, 2003).

Table 2: Common Nosocomial Infections

Common Pathogens	Less Common Pathogens	Site of Infection
Pseudomonas aeruginosa Staphylococcus aureus Candida sp. Coagulase negative staphylococci	Enterococci Klebsiella sp. Serratia marcescens Enterobacter sp. Malassezia sp.	Bloodstream/sepsis
Gram-negative bacilli Enterococci	Candida sp.	Urinary tract
S. aureus Coagulase negative staphylococci	Enterococci S.marcescens Aspergillus sp.	Skin/soft tissue/surgical site
S. aureus P. aeruginosa Coagulase negative staphylococci Respiratory syncytial virus	Enterococci Klebsiella sp. S. marcescens	Pneumonia
S. aureus Coagulase negative staphylococci	Candida sp.	Endocarditis
Coagulase negative staphylococci S. aureus	S.marcescens Enterobacter sp. Candida sp.	Central nervous system

 

There is preliminary evidence that probiotic type microorganisms may control the growth of nosocomial pathogens (Falagas and Makris, 2009).The aim of this review is to consider the current evidence on the effects of probiotics for control of nosocomial infections.

Control of Nosocomial Infections by Probiotics

Due to concerns regarding development of antibiotic resistance in hospitals, rising healthcare costs and lack of new antimicrobial classes being developed, probiotics have been considered a good prophylactic or therapeutic alternative in numerous conditions. Probiotics do not have the risk of antimicrobial resistance and offer practical benefits like low-cost preparation, long shelf life, and ease of administration (Oudhuis et al, 2011) .We identified 29studies involving in-vitro experiments on the potential role of probiotics in the inhibition of nosocomial pathogens (bacterial or fungal) (Table 3).

Table 3 : In-vitro Studies Regarding the Effect of Probioticsin the Inhibition of Nosocomial Pathogens

Probiotic used	Isolated from	Nosocomial pathogens	Region	Reference
L. plantarum, L. delbruekii, L. acidophilus, L. brevis, L. casei	Sausages	S. aureus	Iran	Nowroozi et al., 2004
Lactobacillus and Bifidobacterium spp.	Probiotic Milk	S. aureus ATCC 25922 S. pneumoniae ATCC 41619	USA	Rosario et al., 2005
L. casei L. bulgaricus	Various Foods	P.aeroginosa, S. aureus Klebsiella Enterobacter	Turkey	Erdourul and Erbulur, 2006
L. plantarum L. casei subsp. Paracasei L. casei	Standard	P. aeruginosa S. aureus	Romania	Iordache etal., 2008
Lactobacillus spp.	Yogurt Cheese	S. aureus MRSA P. aeruginosa E. coli	Bulgaria	Petrova etal.,2009
L. acidophilus B. animalis L. paracasei subsp. paracasei Propionibacterium freudenreichii subsp.shermanii	Satandard	S. aureus E. coli	Australia	Tharmaraj and shah, 2009
L.   acidophilus B. bifidum	Probiotic Tablet	S. aureus PTCC 1431 P. aeruginosa ATCC 27853 E. coli PTCC 1399	Iran	Darsanaki et al., 2011
L. lactis L. delbrecukii	Traditional Dairy Product	S. aureus E. coli	Sudan	Salih et al., 2011
Lactobacillus, Streptococcus and Bifidobacterium spp.	Yoghurt	S. aureus, E. coli, P. aeruginosa.	Iran	Hami et al., 2011
L. bulgaricus	Yoghurt	E. coliATCC 10536 S. aureus ATCC 6538	Pakistan	Maria etal, 2011
Lactobacillus spp.	Traditional Dairy Products	E.coli PTCC1399	Iran	Jafari etal, 2011
Lactobacillus, Bifidobacterium, Lactococcus andStreptococcus	Cabbage, Milk, Cheese and Human origin	E. coli S. aureus	United Kingdom	Tejero etal., 2012
L. Plantarum L. casei L. brevis	Fresh Vegetables	S. aureus PTCC 1431 E. coli PTCC 1399	Iran	Darsanaki et al., 2012
Lactobacillusand Streptococcus spp.	Fermented Toddy	Enterobacter E.coli Klebsiella sp. S. aureus	India	Krishnamoorthy and Arjun, 2012
L. acidophilus L. casei L. brevis	Traditional Yoghurt	E. coli PTCC1399 S. aureus PTCC 1431	Iran	Issazadeh1 et al., 2013
Lactobacillusand Bifidobacterium spp.	Cheeses Yoghurt, Milk Kishk	S. aureus E. coli	Egypt	Ali etal., 2013
Lactobacillus, Bifidobacterium and Propionibacterium sp.	Sourdough, Vegetables, Yoghurt, Cheese and Human origin	E. coli ATCC 25922 E. coli ATCC 8739 S. aureus ATCC 25093 P. aeruginosa ATCC 9027 S. aureus ATCC 6538 Aspergillus	Bulgaria	Denkova et al., 2013
L. acidophilus L. bulgaricus, L. casei, L. plantarum	Traditional Yoghurt	P. aeruginosa, S. aureus (MRSA)	Iraq	Ahmed, 2013
Lactobacillus spp.	Yoghurt Milk	E. coli S. aureus	Saudi Arabia	Abdallah etal., 2013
L. fermentum L. rhamnosus L. plantarum L. casei L. delbrueckii subspp.bulgaricus	Standard	P. aeruginosa, S. aureus	India	Srinu et al., 2013
L. bulgaricus S. thermophiles L. lactis	Dairy products	Enterococcus S. epidermitidis	Algeria	Mezaini and Bouras, 2013
L. plantarum	Grass silage	E. coli	India	Prema, 2013
L. sakei subsp sakei PTCC 1712 L. casei subsp casei PTCC 1608 L. plantarum subsp plantarum PTCC1745 L. lactis subsp lactis PTCC 1336	Standard	S. aureus Clinical S. aureus PTCC 1431 E. coli Clinical E. coli PTCC 1399	Iran	Chakoosari et al, 2014
L. acidophilus L. Plantarum L. casei L. delbrueckii subsp. bulgaricus	Commercial Yoghurt	E. coli PTCC1399 S. aureus PTCC 1431	Iran	Tajehmiri et al., 2014
L. plantarum L. rhamnosus L. casei L. acidophilus L.   brevis	Traditional Yogurt	E. coli PTCC1399 S. aureus PTCC 1431	Iran	Nasiri Moslem et al., 2014
Lactobacillus ssp.	Standard	S. aureus MTCC1144 E. coli 0157:H7	India	Vij etal., 2014
Bifidobacterium Lactobacillus Spp.	Commercial probiotic strains	P. aeroginosa PTCC 1707 S. aureus PTCC 1431 Enterococci	Iran	Darabi etal., 2014
Lactobacillus spp.	Fermented Rice	Candida spp. E. coli ATC 259222	Srilanka	Jeygowri etal., 2014
Lactobacillus spp.	Human origin	S. epidermidis ATCC 12228 E. coli ATCC 29181 S. aureus	Malaysia	Shokryazdan etal., 2014

 

Conclusion

However, there are still many questions to be answered before probiotics can be used routinely as therapy. At presence, with increasing of the antibiotic resistance and side effects of chemical drugs, it seems, we need to use alternative remedies. Probiotics can have therapeutic application in future.

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