Probiotics reduce odds of C. difficile infection during antibiotic treatment
Providing multistrain probiotics to pediatric and adult patients treated with antibiotics reduces the likelihood of Clostridium difficile infection, with no difference in serious adverse events when compared with standard care, according to research published in Infection Control & Hospital Epidemiology.
“An individual patient’s risk of developing [C. difficile infection (CDI)] differs based on numerous host and environmental factors, most importantly antibiotic exposure, which is thought to disrupt the intestinal microbiota, allowing C. difficile to proliferate,” Bradley C. Johnston, PhD, associate professor in the department of community health and epidemiology at Dalhousie University, Nova Scotia, and colleagues wrote. “Probiotics, defined as live microorganisms that, when administered in adequate amounts, may confer a health benefit on the host, are a potential CDI prevention strategy.”
The researchers conducted a meta-analysis that examined whether probiotic prophylaxis effectively reduced CDI in adult and pediatric patients. They included 18 randomized controlled trials that measured the effects of prophylaxis with placebo or standard care and had individual patient data.
Johnston and colleagues observed that the use of probiotic prophylaxis reduced the likelihood of infection in both the unadjusted (n = 6,645; OR = 0.37; 95% CI, 0.25-0.55) and adjusted models (n = 5,074; OR = 0.35; 95% CI, 0.23-0.55). An increased risk for infection was observed in patients who received two or more antibiotics (OR = 2.20; 95% CI, 1.11-4.37). Other patient characteristics, including age, sex, hospitalization status and high-risk antibiotic exposure, did not affect the odds of CDI.
Probiotics that included multiple species, rather than single-species probiotics, were more beneficial to patients vs. standard care, the researchers said. Additionally, patients benefited from probiotic prophylaxis in settings where the likelihood of developing CDI was 5% or higher.
Fourteen studies reported on serious adverse events, with no significant differences occurring between the intervention and control groups (12.4% vs. 12.1%). Those who were older (OR = 1.03; 95% CI, 1.02-1.04), used multiple antibiotics (OR = 1.6; 95% CI, 1.25-2.05) and were administered high-risk antibiotics (OR = 1.36; 95% CI, 1.06-1.74) were at significantly higher risk of serious adverse events.
“As with previous aggregate-data meta-analyses, we found no significant difference between species or strains, suggesting that specific effects based on the type of probiotic may not be an important factor to consider when choosing a probiotic,” Johnston and colleagues wrote. “Instead, it is probably more important to consider the quality of the product and credibility of the manufacturer and to use a product that has been investigated in randomized controlled trials, particularly a multistrain product given our findings.” – Katherine Bortz
Disclosures: Johnston reports a grant from BioK+ International for work outside this study. Please see the study for a list of all other authors’ relevant financial disclosures.