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Technology and health care for the elderly medical research studies

Focus on strategic priorities that have significant social impact.

TG2015-20

PROSPECT: Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial

The PROSPECT Trial is key to the ongoing search for more effective strategies to prevent serious infection during critical illness in elderly patients around the world. 

Possible Research Results

Anticipated Findings: Probiotics may prevent ventilator-associated pneumonia (VAP), decrease other ICU-acquired infections such as Clostridium difficile infection (CDI) and antibiotic-associated diarrhea, and reduce overall antibiotic use, particularly in older adults living with frailty.

Impact of Findings: Preventing VAP is a patient safety priority due to the high risk of death and health care costs.  Thus, there is great interest in effective prevention strategies that lower infection rates; as they will also reduce antimicrobial use, and thus antimicrobial resistance. 

About the Project

Probiotics are defined as live bacteria thought to have health benefits when taken by mouth.  Studies in the intensive care unit (ICU) found that patients who receive probiotics experience a 25% reduction in lung infection, known as ventilator‐associated pneumonia (VAP), and 18% reduction in the chance of developing any infection in the ICU.  Although probiotics also seem to reduce antibiotic associated diarrhea and Clostridium difficile infections, this has not been properly evaluated. Elderly patients are at particularly high risk for infections due to their aging immune system.  

Despite the use of advanced technology, critically ill older adults living with frailty typically have poor outcomes following their ICU admission. Previous research with family members, the Canadian Critical Care Trials Group and other partners affirm that if available, inexpensive interventions that decrease risk of infection during critical illness will be readily used for frail older patients.

VAP prevention is a major focus of the national quality improvement campaign (Safer Healthcare Now!), Accreditation Canada and the Canadian Patient Safety Institute, which aim to reduce world-wide concerns of antimicrobial resistance and hospital‐acquired infections. PROSPECT results will be incorporated into guidelines to inform global practice. Probiotics may be an easy‐to‐use, readily available, inexpensive approach to help reduce serious infections in older critically ill patients.

For more details on the project rationale, hypothesis, objectives and research plan, click here

Project Team

Principal Investigator: 

Deborah Cook, MD, MSc (Epid), FRCPC, DABIM, CCM, CAHS, FRS  -- McMaster University

Co-Investigators:

Ian Ball, MD -- Western University

Emmanuel Charbonney, MD -- Université de Montréal

Laurence Chau, MD -- Oakville Trafalger Hospital

Robert Cirone, MD -- St. Joseph's Health Centre

Peter Dodek, MD -- University of British Columbia

Martin Girard, MD -- Université de Montréal

Eyal Golan, MD -- University of Toronto

Rick Hall, MD -- Dalhousie University

William Henderson, MD -- University of British Columbia

Margaret Herridge, MD -- University of Toronto

Jennie Johnstone, MD -- Dalla Lana School of Public Health, University of Toronto/Public Health Ontario

Tim Karachi, MD -- McMaster University

Kosar Khwaja, MD -- McGill University

Arnie Kristof, MD -- McGill University

Jim Kutsiogianis, MD -- University of Alberta

François Lamontagne, MD -- Université de Sherbrooke

François Lauzier, MD -- Université Laval

John Marshall, MD -- University of Toronto

Lauralyn McIntyre, MD -- University of Ottawa

Maureen Meade, MD -- McGill University

Sangeeta Mehta, MD -- University of Toronto

Andrew Morris, MD -- University of Toronto

Daniel Ovakim, MD -- University of British Columbia

Joe Pagliarello, MD -- University of Ottawa

Brenda Reeve, MD -- Brantford General Hospital

Bram Rochwerg, MD -- McMaster University

Lehana Thabane, PhD -- McMaster University

Gordon Wood, MD -- University of British Columbia

Ryan Zarychanski, MD -- University of Manitoba/CancerCare Manitoba

Project Contact: Dr. Deborah Cook -- debcook@mcmaster.ca

TG 2015-20

Key words: probiotics, critically ill, randomized controlled trial, pneumonia, infection, clostridium difficile, diarrhea, intensive care unit, frailty