Can Mycobacterium indicus pranii improve outcomes of Sepsis patients?

Recently published paper investigates the effectiveness of Mycobacteria indicus pranii (MIP) in enhancing clinical outcomes in sepsis patients. Sepsis is a major health concern, particularly in India. The authors conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) focusing on 28-day mortality as the primary outcome and several secondary outcomes like ICU stay duration, days on vasopressor support, ventilator-associated pneumonia (VAP), secondary infections, and delta sequential organ failure assessment (SOFA) score. The dysregulated host immune response in sepsis and the influence of factors such as pre-morbid conditions and prompt therapeutic interventions are highlighted.

The paper explains that immunomodulatory agents like MIP are potential solutions to counteract the immunosuppressive state caused by sepsis. It details the pathways activated by lipopolysaccharide and the potential of immunomodulatory agents to counteract the immunosuppressive state caused by sepsis. The authors mention that previous studies have shown a significant decrease in mortality, fewer days on mechanical ventilation, and reduced hospital and ICU stay duration with MIP.

The systematic review included two RCTs, enrolling a total of 252 participants and revealed a 43% lower mortality rate in the MIP group than in the control group. Other outcomes such as days on vasopressor, length of ICU stay, secondary infection, VAP, CRBSI, and delta SOFA score were also analyzed. The analysis indicated a trend in the reduction of death and lower secondary infections in the MIP group compared to the control, although statistical significance was not achieved.

The paper acknowledges limitations, including a small number of included studies and a high degree of heterogeneity among them, and highlights the need for well-designed RCTs to further investigate the role of MIP in sepsis patients. The findings suggest preliminary evidence for a positive association of MIP with better outcomes in sepsis patients, indicating the importance of conducting future RCTs to determine its precise role in treating sepsis patients.

Reference –

Saran, Khushboo; Iyengar, Swathy S.1; Sinha, Nitesh2; Abhishek, Kumar3; Kumar, Amit4; Prakash, Jay5. Role of Mycobacterium indicus pranii in clinical outcomes in patients with sepsis: A systematic review and meta-analysis of randomised controlled trials. Indian Journal of Anaesthesia 67(12):p 1029-1035, December 2023. | DOI: 10.4103/ija.ija_726_23