Effects of a predictive preventive model for prevention of Clostridium difficile infection in patients in intensive care units

Perils and pitfalls of probiotic quasi-experimental studies for primary prevention of Clostridioides difficile infection: A review of the evidence

“…In 1 study with 3 study wards testing a 1-year study intervention, 1 of 3 wards only used the probiotic for 6 months instead of a full year. 25 Fourth, compliance to the probiotic was generally low, ranging from 39%, 30 to 44%, 27 to 80%, 25 while four studies did not report compliance in their papers. 26,28,29,34 Fifth, most studies did not document if there were any infection control practice changes during the baseline or study periods and 1 study started a new infection control bundle and probiotic use at the same time.…”

“…These studies tested 1 of 4 different types of probiotics: L. casei Shirota (''Yakult'' Yakult Honsha, Tokyo, Japan), 25 or L. plantarum 299v (''SanProbi AB,'' Probi AB, Lund, Sweden), 26 or a symbiotic S. boulardii DBVPG6763 and MOS (''Sacchaflor,'' PharmaForce, Copenhagen, Denmark), 27 or a 3-strain mixture of Lactobacilli composed of L. acidophilus CL1285, L. casei LBC80R, and L. rhamnosus CLR2 (''Bio-K+,'' Bio-K Plus International, Inc., Qusebec, Canada). [28][29][30] In addition, we found 12 other studies in the literature relating to the above mentioned intervention studies. Three studies provided follow-up data on CDI rates when probiotic interventions were continued for 6-10 years 31,32 or 15 years 33 ; one other study reported CDI rates 1 year after a probiotic intervention was discontinued, 34 3 studies assessed cost savings of a probiotic intervention, 16,35,36 4 other studies were reviews or commentaries on these earlier probiotic intervention studies [37][38][39][40] and 1 study retrospectively added an extended baseline period.…”

“…[25][26][27][28][29][30] Four different types of probiotics were tested: L. casei Shirota, 25 L. plantarum 299v, 26,34 a synbiotic comprised of S. boulardii DBVPG-6763 and mannanoligosaccharide (MOS), 27 or a 3-strain mixture of Lactobacilli (L. acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2). [28][29][30] One study updated CDI rates 1 year after the L. plantarum 299v was discontinued. 34 The number of study wards/ units ranged from one 30 to 2 wards 26,28,29 to 3 wards.…”

“…Three studies used a 3-strain mixture of Lactobacilli (L. acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2, ''Bio-K+'') on a limited ward basis. [28][29][30] Bussieres et al gave the Lactobacilli mixture (1 £ 10 11 cfu/d) to inpatient adults on antibiotics who were admitted to 1 of 2 internal medicine wards at a hospital in Canada (Hopital de l'Enfant-Jesus). 28 Compared to the 1-year period before the intervention, CDI increased from 2.2% to 6.0%.…”

“…Cruz-Betancourt et al gave this 3-strain Lactobacilli mixture (''Bio-K+'') to high-risk patients admitted to 1 vascular-thoracic intensive care unit at 1 hospital in Florida. 30 Patients considered at high risk for CDI included patients aged ≥65 years old, length of stay≥5 days, prior quinolone use, or prior other antibiotic use ≥5 days). Over a 1-year study period, high-risk patients admitted to ICU were given a bundled' intervention (infection control education of staff and visitors, identification of CDI patient by stickers and signs, strict environmental cleaning for high touch areas, bleach wipes available, pharmacist review for proper antibiotic use and PPI use, and offered the probiotic (1 £ 10 11 cfu/d) if on prolonged antibiotics).…”