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Growing number of hospitalized patients receive probiotics despite insufficient efficacy data
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A significant and growing number of hospitalized patients are being treated with probiotics despite a lack of evidence supporting their use in this patient population, according to recent study data.
While prior studies “provide a useful starting point in the description of probiotic utilization in the inpatient setting … a study with a larger sample of hospitals that quantifies inpatient probiotic utilization and provides clinical context is needed to inform clinical guidance, public health efforts, and research directions,” L. Clifford McDonald, MD, from the CDC’s division of healthcare quality promotion, and colleagues wrote. “The primary objective of this study, therefore, was to assess and characterize the prevalence of probiotic use from a sample of 145 U.S. hospitals.”
L. Clifford McDonald
McDonald and colleagues performed a two-part study consisting of a cross-sectional study of prevalence of probiotic use in 2012 and a longitudinal study of probiotic use in a subset of hospitals from 2006 to 2012. They estimated inpatient probiotic use with Truven Health MarketScan Hospital Drug Database records.
In 2012, probiotic use was identified in 2.6% of 1,976,167 hospitalizations and in 96% of 145 hospitals. Probiotic use ranged from 0.3% to 8.5% of discharges at the hospital level.
Patients who received probiotics had the following characteristics:
- older age (median age, 70 years vs. 57 years);
- longer mean length of stay (8.8 vs. 4.4 days);
- higher hospital charges ($63,732 vs. $34,130);
- almost nine times higher likelihood of receiving antimicrobials (OR = 8.6; 95% CI, 8.3-8.8);
- 21 times higher likelihood of Clostridium difficile infection (95% CI, 20.4-21.7);
- higher likelihood of being admitted from another inpatient facility (OR = 1.4; 95% CI, 1.4-1.5); and
- higher likelihood of being transferred to another facility at discharge (OR = 2.9; 95% CI, 2.8-2.9; all comparisons, P < .0001).
The most common probiotic formulations were Saccharomyces boulardii (32%), Lactobacillus acidophilus and Lactobacillus bulgaricus (30%), L acidophilus (28%) and Lactobacillus rhamnosus (11%). The most common diagnoses in those who received probiotics included infectious, inflammatory and gastrointestinal conditions.
Among the 60 hospitals included in the trend analysis, probiotic use increased from 1% of 1,090,373 discharges in 2006 to 2.9% of 1,006,051 discharges in 2012, with an annual 1.2-fold increase (95% CI, 1.1-1.3) and an overall 2.9-fold increase (95% CI, 1.8-4.5; both, P < .0001).
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” the researchers wrote. “Currently, there is not enough evidence to support use of currently available probiotics in this clinical setting.”
They concluded that further research is “critically needed to guide the use of these agents in the hospital setting.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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