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Letter

Probiotics do not significantly reduce nosocomial pneumonia

Luciano Silvestri1*, Hendrick KF van Saene2 and Dario Gregori3

Author Affiliations

1 Department of Emergency, Unit of Anesthesia and Intensive Care, Presidio Ospedaliero, Via Fatebenefratelli 34, 34170 Gorizia, Italy

2 Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool L69 3GA, UK

3 Department of Cardiological, Thoracic and Vascular Sciences, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, 35133 Padova, Italy

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Critical Care 2012, 16:453  doi:10.1186/cc11654


See related research by Liu et al., http://ccforum.com/content/16/3/R109

Published: 5 November 2012

First paragraph (this article has no abstract)

Liu and colleagues, in their recent meta-analysis, concluded that probiotics were associated with a statistically significant reduction in the incidence of nosocomial pneumonia (NP) (odds ratio = 0.75; 95% confidence interval = 0.57 to 0.97, P = 0.03) [1]. These results were obtained using the fixed-effect model, ignoring a moderate level of heterogeneity (I2 = 46%) [2]. However, we believe that the inclusion criteria, subjects, and interventions were different among the included studies, and might have impacted the results. Good practice would therefore be to choose a more conservative analysis; that is, the random-effects model. Using this model, the claimed reduction in NP would have been not significant (odds ratio = 0.70, 95% confidence interval = 0.46 to 1.05, P = 0.085) (Figure 1). We have already addressed this issue with reference to a previous meta-analysis on probiotics [3,4].