Probiotic Prophylaxis With Clostridium butyricum for Postoperative Infections Following Lung Resection: A Propensity Score–Weighted Analysis

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BACKGROUND: This study investigated the efficacy and safety of perioperative Clostridium butyricum MIYARI 588 (CBM588) for preventing postoperative infections following thoracoscopic anatomic lung resection for primary lung cancer, with the hypothesis of a reduction in organ/space surgical site infection (OSS). Postoperative infections, particularly OSS, are a significant concern after lung resection. Although probiotics have shown promise in reducing infections in gastrointestinal surgery, their role in thoracic surgery is unclear. METHODS: This retrospective, single-center cohort study analyzed 529 patients undergoing thoracoscopic anatomic lung resection for primary lung cancer. The study compared a control group (n = 458, operated on between January 2014 and December 2021) with a probiotic group (n = 71, operated on between April 2020 and December 2021) that received perioperative CBM588 after a change in institutional practice. Inverse probability weighting (IPW) adjusted for baseline and surgical confounders. RESULTS: After IPW adjustment, the probiotic group demonstrated a significantly lower incidence of OSS (odds ratio, 0.08; 95% CI, 0.01-0.64; P = .017). The unadjusted incidence of all postoperative infections was 4.2% (3/71) in the probiotic group vs 9.8% (45/458) in the control group; after IPW adjustment, probiotics were associated with a significantly lower risk of all postoperative infections (odds ratio, 0.26; 95% CI, 0.07-0.95; P = .042). No significant differences were found in overall complication rates, IPW-adjusted hospital stay, 30- or 90-day mortality, reoperation, or readmission rates. An unadjusted subgroup analysis revealed a minor reduction in hospital stay for noncomplicated patients. CONCLUSIONS: Perioperative CBM588 may reduce OSS and all postoperative infections following thoracoscopic anatomic lung resection, suggesting a potential prophylactic benefit.

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