Can Probiotics Fend Off Clostridium difficile?

A study presented at Digestive Disease Week found that probiotics can guard against Clostridium difficile infection in hospitalized patients receiving antibiotics.

A team including researchers from New York Presbyterian-Weill Cornell Medical Center conducted a meta-analysis of 19 studies published from 1986 to 2016, including PLACIDE, the largest randomized controlled trial to evaluate the protective effects of probiotics for this patient population. Overall, the researchers’ analysis included 6492 hospitalized adults taking antibiotics and receiving either a probiotic or placebo as prevention for C difficile infection. The authors saw a significant difference in the incidence of infection between the probiotic and placebo groups, with the probiotic found to be most effective in studies with the highest incidence of infection.
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In addition, prespecified subgroup analyses found no differences in probiotic species, strain, formulation, or dose but did reveal the importance of when a probiotic is administered. The overall relative risk for infection was 0.41, which decreased to 0.32 when the probiotic was delivered within 2 days of the first antibiotic dose. When the probiotic was administered more than 2 days after the first antibiotic dose, the risk reduction was much lower, the authors noted.

These findings suggest that “concurrent probiotic use with antibiotic use in immunocompetent hospitalized patients taking antibiotics reduces the risk of C. difficile infection by greater than 50%, with increased efficacy observed if the probiotic course is started within 2 days of the first antibiotic dose,” said study coauthor Nicole Shen, MD, an internal medicine resident at New York Presbyterian-Weill Cornell Medical Center.

The randomized controlled trials in this meta-analysis evaluated probiotic use in immunocompetent patients, “without underlying gastrointestinal disease such as pancreatitis or inflammatory bowel disease, or mechanical heart valves,” said Dr Shen, noting there were no reports of probiotic sepsis, and reported adverse events were equally distributed among the probiotic and control cohorts.

“Given these findings,” she said, “primary care practitioners should consider advising their immunocompetent hospitalized patients receiving antibiotics to [also give thought to] taking a probiotic to reduce their risk of C. difficile, particularly their older patients who are at higher risk for [the infection].”

—Mark McGraw

Reference:
Shen NT, Tmanova LL, Pino A, et al. The use of probiotics for the prevention of clostridium difficile infection (cdi) in hospitalized adults receiving antibiotics: a systematic review and meta-analysis. Paper presented at: Digestive Disease Week 2016; May 26, 2016; San Diego, CA. http://www.ddw.org/program/online-planner. Accessed May 26, 2016.