Probiotic Interventions in Postoperative Infection Management

Postoperative infections remain a major source of morbidity and resource utilisation in surgical practice, contributing to prolonged hospital stays, increased antibiotic use and elevated healthcare costs. Probiotic interventions aim to prevent or mitigate these complications by modulating the gut microbiota, reinforcing mucosal barrier integrity and shaping host immune responses. Mechanistically, selected bacterial strains compete with pathogens for adhesion sites, enhance epithelial tight-junction function, stimulate antimicrobial peptide production and recalibrate inflammatory signalling. Clinical evidence, particularly in abdominal and colorectal surgery, indicates that perioperative probiotic or synbiotic administration can reduce surgical-site infections, pneumonia and sepsis, shorten time to first flatus and defecation, and decrease antibiotic duration. Optimisation of strain selection, dosing regimens and treatment timing is under active investigation. As antibiotic resistance escalates globally, microbial therapies offer a complementary strategy to support recovery, with potential benefit across diverse healthcare settings. Standardised protocols, multicentre trials and personalised approaches guided by microbial diagnostics are anticipated to consolidate the role of probiotics in surgical infection control.

Research from Nature Portfolio

Recent studies have refined the concept of synbiotics, emphasising the cooperative design of microbial strains and substrates to enhance host benefit. A consensus panel established clear criteria to distinguish synergistic synbiotics—where substrates are specifically utilised by co-administered microorganisms—from complementary formulations that combine independent probiotic and prebiotic components. This framework defines evidence thresholds for health claims, outlines safety considerations and provides guidance on dose requirements. By standardising definitions and regulatory benchmarks, the consensus statement supports the development of perioperative preparations aimed at fortifying mucosal resilience, optimising immune modulation and reducing susceptibility to postoperative infections.

Probiotic Interventions in Postoperative Infection Management publication trend

The graph below shows the total number of articles in probiotic interventions in postoperative infection management across all publications each year (not limited to Nature Index journals).

Technical terms

Probiotics: Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.

Synbiotics: Preparations combining probiotics and substrates that selectively support the growth or activity of those microorganisms for a synergistic health benefit.

Dysbiosis: A detrimental imbalance in the composition or function of the microbial community, often associated with disease.

Perioperative: Relating to the period immediately before, during and after a surgical procedure.

Intestinal barrier function: The capacity of the gut mucosa to regulate permeability, prevent translocation of pathogens and maintain immune homeostasis.

References

1. Probiotics fortify intestinal barrier function: a systematic review and meta-analysis of randomized trials. Frontiers in Immunology (2023).
2. The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics. Nature Reviews Gastroenterology & Hepatology (2020).
3. Perioperative Probiotics or Synbiotics in Adults Undergoing Elective Abdominal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.. Annals of Surgery (2019).
4. Postoperative changes of the microbiome: are surgical complications related to the gut flora? A systematic review. BMC Surgery (2017).
5. The effect of perioperative probiotics treatment for colorectal cancer: short-term outcomes of a randomized controlled trial. Oncotarget (2016).