Timing of probiotic administration modifies CDI risk in hospitalized patients
The risk of Clostridium difficile infection (CDI) in hospitalized patients may be halved by a strategy of administering probiotics within 2 days of antibiotic initiation, according to the results of a systematic review.
Researchers searched databases for trials examining the association between probiotic use and CDI in hospitalized adult patients receiving antibiotics. CDI incidence and adverse events were the primary and secondary outcomes of interest, respectively. The bias risk and overall evidence quality, as well as the effects of probiotic species, dose, timing, formulation and duration were also assessed.
The pooled data from 19 studies involving 6,261 patients showed that the group of those who received probiotics (n=3,277) had a lower CDI incidence compared with the control group (n=2,984; 1.6 vs 3.9 percent; p<0.001). Probiotic use was associated with a 58-percent reduction in the risk of CDI (relative risk [RR], 0.42; 95 percent CI, 0.30 to 0.57; I2=0.0 percent).
The CDI risk-lowering effect was significantly greater when probiotics were given within 2 days of antibiotic initiation (RR, 0.32; 0.22 to 0.48; I2=0 percent) than when given at a later time (RR, 0.70; 0.40 to 1.23; I2=0 percent; p=0.02). There was an observed decrement in efficacy for each day of delay in administering probiotics (p=0.04).
Probiotics did not appear to increase the risk of adverse events, and the overall quality of the evidence was high.
Comprising live or live-attenuated microorganisms that provide a health benefit to the host, probiotics act against C. difficile by potentially suppressing germination, colonization and adhesion of bacterial spores or vegetative cells and by inhibiting its toxins. Probiotics also helps stimulate immune function, enhance barrier function and prevent epithelial cell apoptosis. [Chen X, et al. Mechanisms of action and applications of probiotics for the treatment of Clostridium difficile infection. In: Méndez-Vilas A, ed. Microbial pathogens and strategies for combating them: science, technology and education. Formatex Research Center: 2013]