Lactobacillus probiotic improves C. difficile infection rates at hospital
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The rate of hospital-acquired Clostridioides difficile infection improved by 39% at a Quebec hospital when 70% of antibiotic users took a three-strain Lactobacillus probiotic under a pharmacy-driven protocol, researchers reported.
Additionally, among those who took the probiotic with multiple antibiotics or one single high-risk antibiotic, the CDI incidence declined by at least half, according to results published in Clinical Infectious Diseases.
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“We decided to do a massive primary prevention of CDI with a probiotic in a hospital that has had an endemic CDI problem for more than 20 years,” Pierre-Jean Maziade, MD, clinical advisor in the Department of Microbiology and Infectious Disease at Lanaudière Integrated Health and Social Services Center, told Healio.
Starting in 2016, the hospital restricted quinolone antibiotic use and replaced azithromycin with doxycycline as the principal treatment for community-acquired pneumonia, Maziade and colleague reported. According to the study, on Oct. 16, 2017, the hospital implemented a clinical order set for the three-strain probiotic preparation. Adult inpatients prescribed 2 or more days of antibiotics were flagged to receive the probiotic daily within the first 24 hours.
According to the study, eligible adults took up to two capsules of a probiotic made of Lactobacillus acidophilus CL1285, Lacticaseibacillus (Lactobacillus) casei LBC80R and Lacticaseibacillus (Lactobacillus) rhamnosus CLR2 daily throughout the antibiotic treatment course, plus an additional 5 days after therapy. Electronic pharmacy records were collected for all antibiotic or probiotic prescriptions to adult inpatients treated at the hospital from Oct. 16, 2016, through March 31, 2019, and patients with at least three loose stools daily and exhibiting signs of possible CDI provided stool samples to the hospital’s microbiology lab for C. difficile toxin A and toxin B testing by enzyme immunoassay.
Overall, records were identified for 13,922 adult inpatient visits where antibiotics were prescribed, representing 4,383 patients in the 12-month observation period and 6,079 patients in the 18-month intervention period.
The study demonstrated that the hospital-acquired Clostridioides difficile infection (HA-CDI) rate was significantly lower during the intervention 5.2 cases per 10,000 patient days compared with 8.6 (P = .002). The proportion of HA-CDI cases with recurrences stayed similar, with 16 (19%) in the observation period and 13 (16%) during the intervention, although the researchers noted that a smaller proportion of the probiotic-treated patients had recurrences (six or 13% vs. seven or 25%).
Additionally, the incidence of HA-CDI among antibiotic users decreased significantly during the intervention 0.9% compared with 1.5% during the observation period. Without accounting for the differential risk of eligible patients, the incidence of HA-CDI was similar when taking the probiotic (OR = 0.69).
According to Maziade and colleagues, when riskier courses of antibiotics were prescribed, patients exposed to multiple antibiotics per visit had a lower incidence of HA-CDI with the probiotic (OR = 0.5).
“The probiotic is safe and cost-effective one case of CDI can cost as much as $25,000 and is strain specific,” Maziade said. “This probiotic inhibits the growth, the toxin production and the sporulation of C. difficile.”
Other studies have found that probiotics did not reduce the rates of facility-onset C difficile in patients taking antibiotics.
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