- Probiotics is the new prevention tool for Clostridium difficile infections (CDI)
- Consuming two or more probiotics can be effective and safe
Probiotics are the new solution for preventing Clostridium difficile
infections (CDI) in hospital settings. They are safe, simple, and low-cost preventive tool.
The results were based on two studies that were published in Infection Control & Hospital Epidemiology,
which is the journal of the Society for Healthcare Epidemiology of America.
‘Probiotics is the new low-cost prevention tool that helps reduce Clostridium difficile infections and is very effective and safe.’
When patients who took antibiotics were treated with multi-strain probiotics, the incidence of CDI has reduced in both the studies. However, this is not a perfect solution for preventing and treating CDI, and this study only suggests that probiotics can be offered to patients as another line of defense.
"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," said Bradley Johnston, Ph.D., associate professor of epidemiology at Dalhousie University in Canada and lead author of one of the studies.
Effect of Probiotics on Clostridium difficile infections (CDI)
A synthesis of randomized controlled trials was conducted at the Dalhousie University in Canada. The research team investigated to see if probiotics could help reduce the incidence of CDI in adults and children.
About two-thirds of the odds of CDI was reduced with probiotics in both their adjusted and non-adjusted models, i.e., adjusting for age, sex, hospitalization status, use of multiple antibiotics, and exposure to high-risk antibiotics.
Also, the research team observed that when participants received multi-species probiotics, they were more beneficial than single-species probiotics or no probiotics.
About 18 eligible randomized controlled trials were analyzed by the research team, where data for 6,851 participants were included.
The research team compared the patients receiving probiotics to placebo or no treatment and reported that CDI as an outcome.
Probiotics were found to be more effective, especially in participants who were taking two or more antibiotics and in settings where the risk of CDI was greater than five percent.
Cook County Health & Hospitals System conducted a second project at a separate tertiary care medical center, where an evaluation was done for single-center before-after quality improvement intervention.
Lower Risk of Clostridium difficile infections (CDI)
The results showed that probiotics produced a delayed benefit in reducing the incidence of CDI. However, during this period, the incidence of CDI decreased in the second six months rather than in the first six months.
The authors hypothesize that the delayed benefit could be due to the time required for environmental contamination with spores of C. difficile that has to be brought under control.
"There is an expanding number of options to prevent or treat the often serious and costly infections caused by C. difficile," said William Trick, MD, a clinician at Cook County Health & Hospitals System and lead author of the study.
"Probiotics are one option that is low cost, relatively safe, and likely beneficial in the long-run."
The research team compared the 12- month baseline and the intervention periods.
Capsules containing a three-strain probiotic mixture were given to the patients, to be taken within 12 hours of taking their antibiotics.
Though the study established the benefits of using probiotics in the fight against CDI, it comes with certain limitations. For example, getting a probiotic agent to suit the right patients at the right time posed a challenge in practical quality improvement interventions and sometimes meant an incomplete use of the intervention. It was also found that the favorable results were not likely to match the results reported in randomized controlled trials (RCTs).
Interventions need to be tested in routine practice settings to show challenges in implementation and to evaluate the replicability of RCT results in different settings.