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 Probiotics Help Prevent Clostridium Difficile Infections, Studies Find

Probiotics may hold the key to preventing Clostridium difficile infections (CDIs) in hospital settings, according to new research published in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. Two studies show that treating patients who received antibiotics with multi-strain probiotics cut down on CDI incidence rates over time.

“While it’s not a perfect solution for a bacterium that has proven very difficult to prevent and treat, probiotics could offer patients another line of defense,” says Bradley Johnston, PhD, associate professor of epidemiology at Dalhousie University in Canada and lead author of one of the studies.

“We worked with clinical trialists from 12 countries that willingly shared their data with us to conduct what is known as an individual patient data meta-analysis, and we demonstrated that we should be considering probiotics as a viable strategy for preventing CDI in patients.”

The research led out of Dalhousie University conducted a synthesis of randomized controlled trials to determine whether probiotics reduced the odds of CDI in adults and children. It found that probiotics reduced the odds of CDI by about two-thirds in both their non-adjusted and adjusted models (adjusting for age, sex, hospitalization status, use of multiple antibiotics, and exposure to high-risk antibiotics). Additionally, they found that compared to no probiotics, multi-species probiotics were more beneficial than single-species probiotics.

The study analyzed 18 randomized controlled trials that included patient data for 6,851 participants comparing probiotics to placebo or no treatment and that reported CDI as an outcome. Probiotics were especially effective among participants taking two or more antibiotics and in settings where the risk of CDI was greater than 5 percent.

According to the Centers for Disease Control and Prevention, CDIs are a type of health care-associated infection that affects about half a million people each year. Caused by the germ Clostridium difficile, they have become more severe and difficult to treat in recent years. Probiotics are defined as live microorganisms that, when administered in adequate amounts, may confer a health benefit on the host and are a potential CDI prevention strategy, according to the study.

A second study was conducted by Cook County Health & Hospitals System in Chicago. The study evaluated a before-after quality intervention at a separate tertiary care medical center, which cares for patients with complicated conditions, and found that probiotics provided a delayed benefit in reducing CDIs. During the intervention period, there was a trend toward a lower incidence of CDIs in the second six months, compared to the first six months.

The authors speculate that the postponed benefit could be attributed to the time required for environmental contamination with spores of Clostridium difficile to be brought under control.

The study compared 12-month baseline and intervention periods. Patients in the study received capsules containing a three-strain probiotic mixture, to be taken within 12 hours of their antibiotics. The primary outcome of the study was the incidence of hospital-onset CDI among participants.

One of the hurdles of the study had to do with getting probiotics to patients at the right time. “Getting probiotics to patients who received antibiotics was a challenge,” says William Trick, MD, clinician at Cook County Health & Hospitals System and lead author of the study. “Because they can receive antibiotics when they come in, in the emergency room, or even after surgery.”

Preventing CDIs in the hospital can be a first step toward better infection control in a long term or post-acute care center, where elderly residents are at high risk for CDIs. “If you prevent the transmission in the hospital, the idea is that there will be less introduction in the long term care setting,” says Trick.

And while probiotics are one low-cost and safe option to prevent CDIs, it’s not the only one, he says. “There are others, including minimizing antibiotic receipt. It’s important for nursing homes to be aware about how they are using antibiotics. Are they judicious or careful in their use?”

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