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Study: Probiotics do not reduce C. difficile in hospitalized patients
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A large retrospective cohort study showed that probiotics did not decrease rates of facility-onset Clostridioides difficile in hospitalized patients taking antibiotics, researchers reported.
Maggie J. Box, PharmD, BCPS, and colleagues from Scripps Health noted in their report that administering probiotics is not an endorsed C. difficile prevention strategy. However, based on a supplement published in 2015 in Clinical Infectious Diseases, their hospital outside of San Diego added a specific combination — Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2 (Bio-K+) — to the formulary and included it in a bundle meant to reduce the risk for hospital onset C. difficile infection (HO-CDI) in patients on antibiotic therapy identified to be at high risk for CDI.
“Our clinicians are always interested in ways to decrease hospital onset Clostridium difficile infection, and many were intrigued by data showing that probiotics can decrease rates of HO-CDI,” Box told Infectious Disease News.
“However, some of the prior data has demonstrated positive outcomes in institutions with much higher CDI rates (greater than 20%) compared to ours. We wanted to assess if probiotic administration decreased HO-CDI rates among hospitalized patients receiving antibiotics in a ‘real world’ environment where HO-CDI rates are lower and more generalizable to other acute care hospitals in the U.S.”
The study was conducted at a 400-bed hospital in La Jolla, California. Box and colleagues included patients aged 18 years or older who received at least one dose of antibiotics and had a length of stay of more than 3 days.
They evaluated 1,576 patients treated with IV antibiotics between March 29 and September 30, 2016, including 649 who received antibiotics and probiotics and 927 who were treated with only antibiotics. According to the study, HO-CDI occurred in 11 (1.8%) of the 649 patients who received probiotics and antibiotics versus eight (0.9%) in the group that received antibiotics alone. Additionally, Box and colleagues noted that patients in the probiotic group had a longer length of stay, a higher Charlson Comorbidity Index and were billed for more antibiotics.
“Probiotic administration to patients receiving antimicrobials did not decrease rates of HO-CDI in our institution. We caution to not let probiotic administration to patients on antimicrobials create a false sense of security in CDI protection, and endorse strong antimicrobial stewardship and infection control practices.” Box said.
They also evaluated whether greater antibiotic exposure in the probiotic group offset a potential therapeutic benefit. They compared HO-CDI rates between the probiotic group with rates in the top 30% of patients by antibiotic exposure in the antibiotic-only group and found no difference.
“Antibiotic use is the most important modifiable risk factor for CDI in acute care hospitals. The Centers for Disease Control estimates that at least 30% of antibiotic use is unnecessary,” the authors concluded. “Based on these findings, our institution removed all probiotics from the formulary. Instead, we endorse strong antimicrobial stewardship practices that are shown to be efficacious and caution that probiotics may consume health care resources without adding additional benefit.”– by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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