Abstract
Background:
Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotic use. The pathogenesis of AAD may be mediated by disruption of the host’s normal flora resulting in overgrowth of pathogens. One of these pathogens is Clostridium difficile. Probiotics may help reestablish the disrupted intestinal flora and help clear the pathogen and its toxins from the host. Although numerous studies have been conducted, results are variable due to study design, type of probiotic, differing dose of probiotic, and duration of treatment. Our study aims to assess the efficacy and safety of the probiotics Lactobacillus GG and Saccharomyces boulardii for the prevention of C. difficile associated diarrhea.
Methods:
Study data were collected from two community hospitals in Kansas City over a period of 5 months. All patients in the study were initiated on antibiotics and were then given probiotics. This study was controlled and not blinded.
Results:
In data from two community hospitals, 816 patients who were being treated with antibiotics prior to the investigation served as a control; 14 (1.72%) had C. difficile Infections. During the study using probiotic administration, 803 patients also being treated with antibiotics prior to the investigation were followed and in this population; five patients (0.62%) contracted a C. difficile infection.
Introduction
Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotic use and occurs in 5–35% of patients taking antibiotic therapy. 1 The pathogenesis of AAD may be mediated by disruption of the host’s normal flora resulting in dysbiosis of normal colonic flora and harmful pathogens. These outbreaks of AAD are usually caused by Clostridium difficile infections. Risk factors for C. difficile infections include the class of antibiotic taken, the health of the patient, and exposure to nosocomial pathogens.1,2 One role of the intestinal microbiota is to act as protection against intestinal pathogens. 3 With the protection decreased by antibiotics, patients are susceptible to C. difficile infections. In Canada, C. difficile infections resulted in 260 million dollars in hospital costs 4 in 2012. Proposed strategies to reduce the incidence of AAD have included restricting the use of broad-spectrum antibiotics and discontinuing unnecessary antibiotics during hospital stays. Recent strategies have also included the use of probiotics in decreasing the incidence of C. difficile associated diarrhea. Probiotics may help reestablish the disrupted intestinal flora, and help clear the pathogen and its toxins from the host.5,6 Although numerous studies have been conducted, results are variable due to study design, type of probiotic, differing dose of probiotic, and duration of treatment. Our study aims to assess the efficacy and safety of the probiotics Lactobacillus GG and Saccharomyces boulardii for the prevention of C. difficile associated diarrhea.
Methods
Study data were collected from two community hospitals in Kansas City over a period of 5 months during index hospitalization. All patients in the study were inpatients and were initiated on IV or oral antibiotics and were then given probiotics. The probiotic was given by mouth within 2 days of the first antibiotic dose. Patients who were unable to take probiotics orally, on H2 blockers, or other acid reducing agents were not included in the study data. All patients were age 60 or older as part of the inclusion criteria for the study. This age group is considered a high-risk population for C. difficile infections. 7 Hospitals had different probiotics on their formulary but the preparation needed to include Lactobacillus GG plus Saccharomyces boulardii in order to be included in the study. No placebo was given to the patients.
Results
This study was controlled and not blinded. In data from two community hospitals, 816 patient who were being treated with antibiotics prior to the investigation served as a control where 14 (1.7%) had C. difficile infections. During the study using probiotic administration, 803 patients also being treated with antibiotics prior to the investigation were followed and in this population, five patients (0.6%) contracted a C. difficile infection. After Chi-squared analysis, the p value was calculated to be 0.04.
Conclusion
The data in this study were significant to correlate that the use of probiotics does reduce the incidence of nosocomial C. difficile infection in 60 years or older patients.
Future plans
After the results of this study, it can be beneficial to recommend that all patients on antibiotics have a probiotics supplement as well. Further studies are necessary to investigate the patient populations and the specific antibiotic classes that probiotic administration would be the most effective. In addition to the 60 years or older age group studied in this investigation, other age groups may be studied to determine effectiveness of probiotic administration. After this study, the investigators plan to further investigate different probiotic strains that may be more efficacious than Lactobacillus GG and Saccharomyces boulardii (Table 1).
Patients with C. difficile infections before and after probiotic administration.
Footnotes
Conflict of interest statement
The authors declare no conflicts of interest in preparing this article.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.