Probiotic use as prophylaxis for Clostridium difficile-associated diarrhea in a community hospital

Hudson, Shelby L.; Arnoczy, Gretchen; Gibson, Heather D.; Thurber, Christina; Lee, Jayne; Kessell, Andrew

doi:10.1016/j.ajic.2018.12.018

Cited by 8 publications

(6 citation statements)

References 8 publications

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“…Hudson et al retrospectively evaluated prophylactic probiotic use in patients receiving broadspectrum antibiotics for at least 3 days. In the 2.5-year study period, 5574 hospital encounters were reviewed and showed a C. difficile-associated diarrhea (CDAD) incidence rate of 0.96% in patients who received probiotics compared to 2.19% in patients who did not receive probiotics (p = 0.007; number needed to treat of 88) [6]. A 2018 meta-analysis and systematic review by McFarland et al evaluated three randomized controlled trials and seven observational studies, and showed a reduced incidence rate of CDI with use of Bio-K+ ® for primary prevention of CDI [7].…”

Section: Discussionmentioning

confidence: 99%

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Influence of Probiotics on the Development of Clostridioides difficile Infection in Patients Receiving Fluoroquinolones

et al. 2021

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Fluoroquinolones are associated with an increased risk of Clostridioides difficile infection (CDI). Probiotic supplementation has been shown to reduce the risk of antibiotic-associated diarrhea with variable effects on CDI. The objective of this study was to evaluate receipt of probiotics on development of primary CDI among hospitalized patients receiving fluoroquinolones. A retrospective cohort was evaluated that consisted of two groups of 100 patients each, admitted August 2018 through August 2020 that received ≥3 days of definitive monotherapy with levofloxacin or ciprofloxacin within 72 h of admission. Primary outcome was incidence of CDI. Secondary outcomes included rates of C. difficile diagnostic stool testing, additional infectious diagnostic testing, and non-CDI related gastrointestinal side effects. Patients on fluoroquinolones who received probiotics had a non-statistically significantly lower incidence in overall cases of CDI compared to those who did not receive probiotics (0% vs. 3%, p = 0.246). Patients who received probiotics had statistically significantly fewer C. difficile diagnostic stool tests performed (4% vs. 16%, p = 0.005) and fewer additional infectious diagnostic testing performed (4% vs. 10%, p = 0.096), respectively. Further research is warranted to optimize and standardize probiotic prescribing in high-risk patients.

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Section: Discussionmentioning

confidence: 99%

“…Probiotic supplementation has been shown to reduce the risk of antibiotic-associated diarrhea and variable effects on primary CDI [6][7][8][9][10]. Due to conflicting and insufficient data, often due to poor quality studies, routine use is not recommended per the 2018 Infectious Diseases Society of America (IDSA) guidelines [11].…”

Section: Introductionmentioning

confidence: 99%

Influence of Probiotics on the Development of Clostridioides difficile Infection in Patients Receiving Fluoroquinolones

et al. 2021

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“…Several studies have been done to understand the potential use of probiotics in treating CDI. More extensive studies are needed to better understand the probiotics’ role in CDI prevention due to inconsistent results [ 98 , 99 , 100 , 122 ]. A study by Allen et al showed that probiotic usage did not have any significant benefit in the prevention of CDI [ 99 ].…”

Section: Therapeutical Strategies Against CDImentioning

confidence: 99%

“…In addition, another study by Heil et al also showed similar results, whereas a multi-year study showed no significant difference when high-CDI-risk patients were given probiotic supplements [ 100 ]. Several studies have shown the benefits of probiotics in treating CDI [ 122 , 123 , 124 ]. A study by Hudson et al showed that patients receiving probiotic supplements and antibiotics had a lower incidence of CDI-associated diarrhea than those who did not receive the probiotic supplements [ 122 ].…”

Section: Therapeutical Strategies Against CDImentioning

confidence: 99%

Gut Microbiota–Gut Metabolites and Clostridioides difficile Infection: Approaching Sustainable Solutions for Therapy

Gurung,

Stricklin,

Wang

2024

Metabolites

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Clostridioides difficile (C. difficile) infection (CDI) is the most common hospital-acquired infection. With the combination of a high rate of antibiotic resistance and recurrence, it has proven to be a debilitating public health threat. Current treatments for CDI include antibiotics and fecal microbiota transplantation, which contribute to recurrent CDIs and potential risks. Therefore, there is an ongoing need to develop new preventative treatment strategies for CDI. Notably, gut microbiota dysbiosis is the primary risk factor for CDI and provides a promising target for developing novel CDI therapy approaches. Along with gut microbiota dysbiosis, a reduction in important gut metabolites like secondary bile acids and short-chain fatty acids (SCFAs) were also seen in patients suffering from CDI. In this review study, we investigated the roles and mechanisms of gut microbiota and gut microbiota-derived gut metabolites, especially secondary bile acids and SCFAs in CDI pathogenesis. Moreover, specific signatures of gut microbiota and gut metabolites, as well as different factors that can modulate the gut microbiota, were also discussed, indicating that gut microbiota modulators like probiotics and prebiotics can be a potential therapeutic strategy for CDI as they can help restore gut microbiota and produce gut metabolites necessary for a healthy gut. The understanding of the associations between gut microbiota–gut metabolites and CDI will allow for developing precise and sustainable approaches, distinct from antibiotics and fecal transplant, for mitigating CDI and other gut microbiota dysbiosis-related diseases.

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“…Exposure to clindamycin, fluoroquinolones, and beta-lactam/beta-lactamase inhibitor combinations has been associated with the highest risk as compared to macrolides, sulfonamides, and penicillin [ 6 ]. On the contrary, some pharmaco-epidemiologic studies have shown a protective effect from statins and probiotics, but this issue remains controversial [ 10 , 11 ]. Recent studies suggest that acid suppression with proton pump inhibitors is correlated with an increased incidence of Cdiff infection.…”

Section: Introductionmentioning

confidence: 99%

Concurrent and Subsequent Co-Infections of Clostridioides difficile Colitis in the Era of Gut Microbiota and Expanding Treatment Options

et al. 2022

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We narratively reviewed the physiopathology, epidemiology, and management of co-infections in Clostridioides difficile colitis (CDI) by searching the following keywords in Embase, MedLine, and PubMed: “Clostridium/Clostridioides difficile”, “co-infection”, “blood-stream infection” (BSI), “fungemia”, “Candida”, “Cytomegalovirus”, “probiotics”, “microbial translocation” (MT). Bacterial BSIs (mainly by Enterobacteriaceae and Enterococcus) and fungemia (mainly by Candida albicans) may occur in up to 20% and 9% of CDI, increasing mortality and length of hospitalization. Up to 68% of the isolates are multi-drug-resistant bacteria. A pivotal role is played by gut dysbiosis, intestinal barrier leakage, and MT. Specific risk factors are represented by CDI-inducing broad-spectrum antibiotics, oral vancomycin use, and CDI severity. Probiotics administration (mainly Saccharomyces and Lactobacillus) during moderate/severe CDI may favor probiotics superinfection. Other co-infections (such as Cytomegalovirus or protozoa) can complicate limited and specific cases. There is mounting evidence that fidaxomicin, bezlotoxumab, and fecal microbiota transplantation can significantly reduce the rate of co-infections compared to historical therapies by interrupting the vicious circle between CDI, treatments, and MT. Bacterial BSIs and candidemia represent the most common co-infections in CDI. Physicians should be aware of this complication to promptly diagnose and treat it and enforce preventive strategies that include a more comprehensive consideration of newer treatment options.

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Probiotic use as prophylaxis for Clostridium difficile-associated diarrhea in a community hospital

Cited by 8 publications

References 8 publications

Influence of Probiotics on the Development of Clostridioides difficile Infection in Patients Receiving Fluoroquinolones

Influence of Probiotics on the Development of Clostridioides difficile Infection in Patients Receiving Fluoroquinolones

Gut Microbiota–Gut Metabolites and Clostridioides difficile Infection: Approaching Sustainable Solutions for Therapy

Concurrent and Subsequent Co-Infections of Clostridioides difficile Colitis in the Era of Gut Microbiota and Expanding Treatment Options

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