Predictors of Clostridium difficile infection and predictive impact of probiotic use in a diverse hospital-wide cohort

Carvour, Martha L.; Wilder, Shane; Ryan, Keenan; Walraven, Carla; Qeadan, Fares; Brett, Meghan

doi:10.1016/j.ajic.2018.07.014

Cited by 22 publications

(22 citation statements)

References 28 publications

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“…In contrast to the above trials, Carvour et al found that statin use may be a predictor for CDI development among hospitalized patients in New Mexico. 36 This study found that probiotic use was associated with CDI development, also contrasting with data from prior studies. 22 Although multivariate regression was used, other confounders may include statin use as a measure of patients more likely to utilize the health-care system or to present to the hospital with symptoms.…”

Section: Discussioncontrasting

confidence: 99%

“…All studies were retrospective in nature and a summary of results can be found in Table 1. [32][33][34][35][36][37][38]…”

Section: Resultsmentioning

confidence: 99%

“…The most recent study included in this review by Carvour et al suggests similar results. 36 As mentioned above, the interaction of statins and C difficile toxins within the Rho pathway remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

“…Flowchart of study inclusion. The most recent of these studies was published in 2018 by Carvour et al 36 This study was a retrospective cohort study of patients over the age of 18 who were admitted to the University of New Mexico Hospital with CDI between May 2011 and August 2016. This study sought to determine predictors of CDI development among hospitalized patients.…”

Section: Effect On CDI Developmentmentioning

confidence: 99%

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Statin Effects on Incidence, Treatment Success, and Mortality of Clostridium difficile Infections

Gaviola

Scribe

Leverett

et al. 2019

Journal of Pharmacy Practice

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Purpose To review the effects of statin use in patients at risk for or diagnosed with Clostridium difficile infection (CDI) on CDI incidence, treatment success, and mortality. Methods A literature search was performed through January 2019 using the following terms: statins, HMG-CoA inhibitors, Clostridium difficile, Clostridium difficile associated diarrhea, and Clostridium difficile infection. Additional references were identified from a review of literature citations. Studies evaluating statin effects on C difficile-related outcomes were included. Results A total of 8 studies were identified for inclusion in this review. All studies were retrospective. Five studies reported the association between statin use and the development of CDI, suggesting that statins may decrease risk of CDI development in patients already on statin. In one study, there was an improved treatment response against CDI with the use of statin. Three retrospective studies evaluated statin use and mortality from CDI and only one study found significant mortality benefit in statin users. Conclusions Statin use may have a protective effect against the development of CDI and improve CDI treatment success; however, it is unclear if use confers a mortality benefit. Current data remain sparse and larger, prospective studies are needed to confirm current results and identify the specific population that may benefit the most from this intervention.

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Section: Discussioncontrasting

confidence: 99%

“…All studies were retrospective in nature and a summary of results can be found in Table 1. [32][33][34][35][36][37][38]…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Effect On CDI Developmentmentioning

confidence: 99%

See 2 more Smart Citations

Statin Effects on Incidence, Treatment Success, and Mortality of Clostridium difficile Infections

Gaviola

Scribe

Leverett

et al. 2019

Journal of Pharmacy Practice

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“…Studies that did find a significant positive effect of probiotics in these conditions were associated with a rarely encountered C. difficile infection rate of over 5%, [61][62][63] and one trial even associated probiotics use with enhanced incidence of C. difficile infections. 64 These conflicting results greatly highlight a need for high-quality, sufficiently powered prospective trials to resolve the usefulness of probiotics in this and other indications. Conflicting findings were also reported in the context of irritable bowel syndrome (IBS), [65][66][67] respiratory infections, 12,[68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84] Helicobacter pylori infections, [85][86][87][88] inflammatory bowel disease, 89 improving antiretroviral treatment, 90,91 and the metabolic syndrome.…”

Section: Probiotics: Decades Of Conflicting Reportsmentioning

confidence: 99%

Probiotics in the next-generation sequencing era

2019

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Technological developments, including massively parallel DNA sequencing, gnotobiotics, metabolomics, RNA sequencing and culturomics, have markedly propelled the field of microbiome research in recent years. These methodologies can be harnessed to improve our in-depth mechanistic understanding of basic concepts related to consumption of probiotics, including their rules of engagement with the indigenous microbiome and impacts on the human host. We have recently demonstrated that even during probiotic supplementation, resident gut bacteria in a subset of individuals resist the mucosal presence of probiotic strains, limiting their modulatory effect on the microbiome and on the host gut transcriptional landscape. Resistance is partly alleviated by antibiotics treatment, which enables probiotics to interact with the host at the gut mucosal interface, although rather than promoting reconstitution of the indigenous microbiome and of the host transcriptional profile, they inhibit these components from returning to their naïve pre-antibiotic configurations. In this commentary, we discuss our findings in the context of previous and recent works, and suggest that incorporating the state-of-the-art methods currently utilized in microbiome research into the field of probiotics may lead to improved understanding of their mechanisms of activity, as well as their efficacy and long-term safety.

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Effect of Probiotic Use on Antibiotic Administration Among Care Home Residents

Butler

Lau

Gillespie

et al. 2020

JAMA

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Question Does a dose of a daily oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 reduce cumulative systemic antibiotic administration days for all-cause, acute infections in care home residents? Findings In this randomized clinical trial that included 310 participants, this daily probiotic combination, compared with placebo, did not significantly reduce antibiotic administration over 1 year (mean cumulative antibiotic administration days, 12.9 days vs 12.0 days). Meaning The findings do not support the use of probiotics for reducing antibiotic administration in older adults living in care homes 3

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Predictors of Clostridium difficile infection and predictive impact of probiotic use in a diverse hospital-wide cohort

Abstract: Emergency department location, high-risk antibiotics, probiotics, and statins were independently predictive of CDI. Further exploration of the relationship between probiotics and CDI, especially in diverse patient populations, is warranted.

Cited by 22 publications

References 28 publications

Statin Effects on Incidence, Treatment Success, and Mortality of Clostridium difficile Infections

Statin Effects on Incidence, Treatment Success, and Mortality of Clostridium difficile Infections

Probiotics in the next-generation sequencing era

Effect of Probiotic Use on Antibiotic Administration Among Care Home Residents

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