Probiotics Found Effective in Preventing Clostridium difficile in Hospitalized Adults Receiving Antibiotics Interview with:

Dr. Nicole Shen New York-Presbyterian/Weill Cornell Medical College

Dr. Nicole Shen

Dr. Nicole Shen
New York-Presbyterian/Weill Cornell Medical College What is the background for this study?

Dr. Shen: Clostridium difficile infection (CDI) is a persistent, healthcare associated infection with significant morbidity and mortality that costs the US billions of dollars annually. Prevention is imperative, particularly for patients at high risk for infection – hospitalized adults taking antibiotics. Trials have suggested probiotics may be useful in preventing CDI. We conducted a systematic review with meta-analysis in this high-risk population, hospitalized adults receiving antibiotics, to evaluate the current evidence for probiotic use for prevention of CDI. What are the main findings?

Dr. Shen: Our systematic review with meta-analysis including 6,942 subjects suggests probiotics effectively prevent CDI with a RR of 0.41 (95% CI, 0.30-0.57).

Subgroup analysis suggested that probiotics given within two days of the first antibiotic dose were more efficacious than those given later with respective RR 0.32 (95% CI 0.21-0.47) and 0.70 (95% CI 0.40-1.23) (p=0.02).

Evidence of efficacy was robust to sensitivity analysis. The overall quality of the evidence by the GRADE criteria was high for the outcome of CDI. Our analysis suggests the magnitude of effect is greater in high-risk populations. This observation may explain why studies with low event rates often failed to demonstrate a statistically significant benefit as they were likely underpowered to do so.

There was no significant difference in adverse events between probiotic and control groups. Importantly, there were no reports of probiotic sepsis. What should readers take away from your report?

Dr. Shen: There have been many RCTs on this topic performed over more than a decade. Our cumulative meta-analysis demonstrates that a statistically significant benefit has been apparent since 2007. The several studies performed since 2007 have only added precision to the estimate of efficacy, which suggests no further studies need to be performed to demonstrate efficacy.

Current clinical practice guidelines should be reassessed to consider incorporating into their recommendations concurrent probiotic use with antibiotic use in immune competent hospitalized adults receiving antibiotics. What recommendations do you have for future research as a result of this study?

Dr. Shen: Further studies should focus on evaluating which probiotic species, dose, and formulation are most effective at preventing Clostridium difficile in hospitalized adults receiving antibiotics. Is there anything else you would like to add?

Dr. Shen: Our analysis of the available evidence strongly suggests that probiotics are safe and effective in preventing CDI in immunocompetent hospitalized patients receiving antibiotics. Clinical guidelines should be updated to reflect this benefit. Thank you for your contribution to the community.

Citation: Abstract presented during 2016 Digestive Disease Week

Abstract 661: The use of probiotics for the prevention of Clostridium Difficile infection (CDI) in hospitalized adults receiving antibiotics: a systematic review and meta-analysis
Note: Content is Not intended as medical advice.

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Last Updated on May 24, 2016 by Marie Benz MD FAAD