Background/Objectives: Severe and recurrent infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa necessitate alternative antimicrobial strategies. Fermented cacao beans represent a niche microbial ecosystem with the potential to harbor beneficial lactic acid bacteria (LAB). This study aimed to isolate and characterize LAB strains from fermented cacao beans in southern Thailand and to evaluate their probiotic potential and antimicrobial activity against MDR P. aeruginosa. Methods and Results: Five Lactiplantibacillus plantarum isolates were identified via MALDI-TOF MS and whole-genome sequencing (WGS). All strains demonstrated antimicrobial activity against 17 clinical MDR P. aeruginosa isolates and CR14 exhibited the largest inhibition zone. The isolates displayed robust probiotic traits, including survival under simulated gastrointestinal conditions. Acid tolerance (pH 2.0) reached 61.15 ± 7.75%, while resistance to pepsin, pancreatin, and bile salts exceeded 88%, 91%, and 92%, respectively. Strong adhesion was confirmed via auto-aggregation (55.02 ± 1.75%), hydrophobicity (45.58 ± 0.96%) and Caco-2 cell attachment (up to 98.11 ± 3.28%). WGS revealed multiple plantaricin-encoding clusters. Coarse-grained molecular dynamic simulations showed that two-peptide plantaricins (plnJ/K and plnNC8-αβ) self-assembled and formed stable pores in bacterial membrane models, confirming a pore-forming antimicrobial mechanism. The strains lacked acquired resistance genes and virulence factors, confirmed by in silico safety assessments. Conclusions: Thus, these L. plantarum strains are promising probiotics for managing MDR P. aeruginosa via functional foods or adjunct therapies.

Background: Synbiotics may improve the effectiveness of antibiotic-based Helicobacter pylori eradication therapy; however, the available evidence remains limited. This systematic review and meta-analysis updated the evidence on the efficacy and safety of adjunctive synbiotics for H. pylori eradication and treatment-related adverse events. Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines and was registered in PROSPERO (CRD420251236314). PubMed, Scopus, Embase, MEDLINE, Web of Science, and Google Scholar were searched from inception to their respective final search dates in November and December 2025 for randomized controlled trials comparing antibiotic-based eradication therapy plus a synbiotic with the corresponding regimen without synbiotics. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for intention-to-treat (ITT), per-protocol (PP), and safety outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE approach. Results: Six randomized controlled trials enrolling 486 participants were included; 446 participants contributed to the ITT analysis and 416 to the PP analysis. One trial was judged to be at high risk of bias, whereas five raised some concerns. The ITT analysis demonstrated improved eradication with adjunctive synbiotics (RR 1.18, 95% CI 1.04–1.34; I² = 44.53%). No significant benefit was observed in the PP analysis (RR 1.06, 95% CI 0.95–1.18; I² = 48.40%). Safety data were available from three pediatric trials (n = 230), with low-certainty evidence suggesting fewer overall adverse events (RR 0.27, 95% CI 0.16–0.45). Conclusions: Adjunctive synbiotics may modestly improve H. pylori eradication and may reduce overall adverse events. However, the eradication benefit was not confirmed in PP analyses, and the safety findings should be interpreted cautiously given the limited pediatric evidence.

ESKAPE pathogens have become a major global health challenge. This study aimed to isolate and characterize LAB from fermented cacao and to evaluate their probiotic properties, preliminary antimicrobial activity against ESKAPE pathogens, safety profiles, and functional bioactivities. Each of P. acidilactici isolates exhibited antibacterial activity against ESKAPE pathogens, with inhibition zone diameters ranging from 10.00 ± 1.00 mm to 23.00 ± 0.00 mm, depending on the isolate and pathogens tested. CR05 was identified as the most promising probiotic candidate, showing the highest survival at pH 2 (69.65 ± 6.66%), strong tolerance to pancreatin (99.95 ± 0.10%), pepsin (89.11 ± 2.38%), bile salts (98.65 ± 0.33%), and favorable adhesion properties, including auto-aggregation, cell surface hydrophobicity, and adhesion to HT-29 intestinal epithelial cells. The safety assessment indicated a notable susceptibility to gentamicin, tetracycline, and chloramphenicol, with resistance to several other tested antibiotics. and showed no hemolytic activity. Three selected isolates were evaluated for minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against ESKAPE pathogens, with MIC and MBC values ranging from 12.5 to 25 mg/mL and 25 to >50 mg/mL, respectively. The strongest inhibitory activity was observed against A. baumannii, P. aeruginosa, and E. aerogenes, with MIC values of 12.5 mg/mL, particularly for isolates CR05 and CR06. Whole-genome analysis identified genes related to stress response and gastrointestinal tolerance and predicted the enterolysin A gene. No acquired antimicrobial resistance genes were detected. These findings suggest that P. acidilactici isolates from fermented cacao are promising probiotic candidates for further investigation in functional food, probiotic, and postbiotic-related applications.