Probiotics temper effects of C. difficile infection

Probiotics reduced new cases of C. difficile-associated diarrhea among patients taking antibiotics by 66 percent.

Medical use of probiotics could be significant in minimizing C. difficile (Clostridium difficile) infection among hospitalized patients taking antibiotics, according to research from The Hospital for Sick Children (SickKids) and McMaster University. The study is published today in Annals of Internal Medicine.

The research team compiled findings from 20 randomized controlled trials including a total of 3,818 patients. The trials tracked rates of probiotic use in inpatients and outpatients who were receiving antibiotics, and analyzed rates of diarrheal illness associated with C. difficile among the groups. Eighteen of the 20 trials studied were of inpatient and outpatient adults, while two studies were of children. Results were similar among these groups.

Overall, use of probiotics reduced the new cases of C. difficile-associated diarrhea among patients taking antibiotics by two-thirds (66 percent), with no serious adverse events attributable to probiotics. Projected onto current rates of C. difficile-associated diarrhea, this would reduce the rate of illness by approximately three patients per one hundred (or 33 per thousand) patients.

“Probiotics are not a magic bullet, but these results suggest that therapeutic probiotic agents, as well as some yogurts and probiotic dairy products, may be vastly under-used in some nursing homes and hospitals,” says lead author Dr. Bradley Johnston. He is a Scientist and Clinical Epidemiologist at SickKids and Assistant Professor of Health Policy, Management and Evaluation at University of Toronto.

Important public health issue
The risk of serious C. difficile infection appears primarily among older hospitalized adults who are exposed to antibiotics.

Up to half of all diarrheal illness in hospital is associated with this infection, which is a significant cause of illness and death in hospitalized adults. From 2009-2011 the Ontario Ministry of Health and Long-Term Care tracked 75 outbreaks in 47 hospitals.

“Minimizing or even preventing C. difficile among vulnerable patients is a high priority for making every hospital as safe as possible for all patients. It’s an important public health issue,” Dr. Johnston adds. He notes that a 2010 University of Ottawa study found that for every 10 patients who acquired C. difficile, one died of the infection.

Further study needed for debilitated children
Because immunocompromised and debilitated children are potentially at risk of systemic infection from probiotics, more research is needed regarding application of these results to children. “We applaud any effort to improve the prevention of C. difficile infection,” adds Dr. Upton Allen, infectious disease specialist at SickKids. “Although this study found no serious adverse events among the populations studied, we need further research into the significance of the results and the safety and efficacy of probiotics in children, notably those with weakened immune systems,” he says. Dr. Allen is Chief, Division of Infectious Diseases, and Senior Associate Scientist at SickKids, and Professor of Paediatrics and Health Policy, Management and Evaluation at the University of Toronto.

Reintroduce healthy bacteria
Probiotic powder and capsules as well as yogurt were included in the studies analyzed. “The results appeared to be even more pronounced when several probiotic organisms were used together,” says Dr. Johnston.

When broad-spectrum antibiotics are prescribed to treat and prevent infections the medications can also destroy necessary healthy bacteria in the colon. Probiotics help to reintroduce healthy bacteria. “That’s why probiotics could be an effective, safe and relatively inexpensive approach to prevent C. difficile-associated diarrheal illness in adult patients whose immune systems are not compromised,” adds Dr. Johnston.

“Because C. difficile forms spores, it is difficult to eradicate from the environment,” says co-author Dr. Mark Loeb. “Probiotics can be easily integrated into the diets of hospitalized patients.” Dr. Loeb is Professor of Pathology and Molecular Medicine and Division Director of Infectious Diseases at McMaster University.


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