Effectiveness of Probiotic for Primary Prevention of Clostridium difficile Infection: A Single-Center Before-and-After Quality Improvement Intervention at a Tertiary-Care Medical Center

Trick, William E.; Sokalski, Stephen; Johnson, Stuart; Bunnell, Kristen; Levato, Joseph; Ray, Michael; Weinstein, Robert A.

doi:10.1017/ice.2018.76

Cited by 17 publications

(29 citation statements)

References 26 publications

(54 reference statements)

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“…As a consequence, one hospital in Canada which was experiencing a persistent large CDI outbreak gave this three-strain Lactobacilli mixture to all inpatients receiving antibiotics and found a significant reduction of CDI rates, which was sustained over 10 years of the program [41]. The reduction of CDI rates was also observed at other Canadian hospitals who added the three-strain Lactobacilli formulation to their infection control programs [42, 43].…”

Section: Resultsmentioning

confidence: 99%

Choosing an appropriate probiotic product for your patient: An evidence-based practical guide

et al. 2018

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IntroductionClinicians and patients face a daunting task when choosing the most appropriate probiotic for their specific needs. Available preparations encompass a diverse and continuously expanding product base, with most available products lacking evidence-based trials that support their use. Even when evidence exists, not all probiotic products are equally effective for all disease prevention or treatment indications. At this point in time, drug regulatory agencies offer limited assistance with regard to guidance and oversight in most countries, including the U.S.MethodsWe reviewed the current medical literature and sources on the internet to survey the types of available probiotic products and to determine which probiotics had evidence-based efficacy data. Standard medical databases from inception to June 2018 were searched and discussions with experts in the field were conducted. We graded the strength of the evidence for probiotics having multiple, randomized controlled trials and developed a guide for the practical selection of current probiotic products for specific uses.ResultsWe found the efficacy of probiotic products is both strain-specific and disease-specific. Important factors involved in choosing the appropriate probiotic include matching the strain(s) with the targeted disease or condition, type of formulation, dose used and the source (manufacturing quality control and shelf-life). While we found many probiotic products lacked confirmatory trials, we found sufficient evidence for 22 different types of probiotics from 249 trials to be included. For example, several types of probiotics had strong evidence for the prevention of antibiotic-associated diarrhea [Saccharomyces boulardii I-745, a three-strain mixture (Lactobacillus acidophilus CL1285, L. casei Lbc80r, L. rhamnosus CLR2) and L. casei DN114001]. Strong evidence was also found for four types of probiotics for the prevention of a variety of other diseases/conditions (enteral-feed associated diarrhea, travellers’ diarrhea, necrotizing enterocolits and side-effects associated with H. pylori treatments. The evidence was most robust for the treatment of pediatric acute diarrhea based on 59 trials (7 types of probiotics have strong efficacy), while an eight-strain multi-strain mixture showed strong efficacy for inflammatory bowel disease and two types of probiotics had strong efficacy for irritable bowel disease. Of the 22 types of probiotics reviewed, 15 (68%) had strong-moderate evidence for efficacy for at least one type of disease.ConclusionThe choice of an appropriate probiotic is multi-factored, based on the mode and type of disease indication and the specific efficacy of probiotic strain(s), as well as product quality and formulation.Trial registrationThis review was registered with PROSPERO: CRD42018103979.

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Section: Resultsmentioning

confidence: 99%

Choosing an appropriate probiotic product for your patient: An evidence-based practical guide

et al. 2018

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“…lactis Bb12 (''Flora-gen3,'' Clarion Brands, Inc., Pennsylvania), 18,19 and 5 studies tested a 3-strain mixture of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R and Lactobacillus rhamnosus CLR2 (''Bio-K+,'' Bio-K Plus International, Inc., Quebec, Canada). [20][21][22][23][24] One study gave 2 probiotics (S. boulardii and a mixture of L. acidophilus and L. bulgaricus ''Lactinex,'' Becton, Dickinson and Company, Sparks, MD) during one period, then switched to a third probiotic mixture (Bio-K+). 22 Published meeting abstracts from 3 studies later published in full papers [21][22][23] were excluded as duplicates.…”

Section: Literature Searchmentioning

confidence: 99%

“…[20][21][22][23][24] One study gave 2 probiotics (S. boulardii and a mixture of L. acidophilus and L. bulgaricus ''Lactinex,'' Becton, Dickinson and Company, Sparks, MD) during one period, then switched to a third probiotic mixture (Bio-K+). 22 Published meeting abstracts from 3 studies later published in full papers [21][22][23] were excluded as duplicates.…”

Section: Literature Searchmentioning

confidence: 99%

“…Five studies tested a 3-strain mixture of Lactobacilli (L. acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2, ''Bio-K+'') using a facility-level intervention design. [20][21][22][23][24] Mazaide et al reported a study based at a hospital (Centre Hospitalier Pierre-Le Gardeur Hospital, Quebec, Canada) experiencing a large outbreak of CDI in 2003 caused by a hypervirulent strain of C. difficile (NAP1/BI/027). 20 Standard infection control practices (isolation of CDI cases, environmental disinfection, antibiotic monitoring and handwashing) failed to abate this problem (CDI rate was 18.4/1,000 admissions).…”

Section: Facility-level Interventionsmentioning

confidence: 99%

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Perils and pitfalls of probiotic quasi-experimental studies for primary prevention of Clostridioides difficile infection: A review of the evidence

McFarland

Johnson

Evans

2021

American Journal of Infection Control

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Background: Primary prevention of Clostridioides (Clostridium) difficile infections (CDI) is an important but challenging infection control goal for hospitals and health care facilities. Enhanced infection control protocols have reduced CDI rates, but the problem persists and administration of probiotics to patients at risk could be very useful if shown to be safe and effective. Randomized controlled trials are largely impractical for primary prevention CDI trials due to large required study sizes and quasi-experimental studies are becoming more frequent as a method to assess this problem. Objective: Our goal is to review the published quasi-experimental studies adding probiotics to their infection control protocols to reduce CDI and determine the strengths and limitations for this type of study design. Methods: The literature was searched using PubMed, Google Scholar, Medline and Cochrane Databases and gastrointestinal meeting abstracts from January 2000 to January 2020 for quasi-experimental intervention studies testing various probiotics for the primary prevention of CDI. Results: We found 28 studies with 7 different types of probiotics (10 studies implementing a hospital-wide intervention, 6 studies targeting 1-3 wards, and 12 studies on either sustainability, cost-effectiveness or subgroup analysis). Some probiotics demonstrated a significant reduction in CDI rates; all four of the probiotic types given only on specific wards and 3 of the 4 probiotics given facility-wide. However, this type of study design was influenced by numerous factors which must be carefully accounted for in the analysis. Conclusions: Some probiotics may be an effective addition to infection control protocols to prevent C. difficile infections, but careful study design considerations are needed.

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“…To the Editor— Implementing a facility-level Clostridium difficile infection (CDI) prevention protocol is a challenging endeavor, and Trick et al 1 should be commended for their early successes at a large institution. As the manufacturers of the probiotic comprising L. acidophilus CL1285, L. casei LBC80R, and L. rhamnosus CLR2 (Bio-K+), we contributed our products to 9,072 patients for this study at no cost to the investigators as well as monetary support for a research assistant to collect data.…”

mentioning

confidence: 99%

Going back to prospectively collected results with a probiotic for primary prevention of Clostridium difficile infection at a tertiary-care medical center

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Carrière

2018

Infect. Control Hosp. Epidemiol.

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Effectiveness of Probiotic for Primary Prevention of Clostridium difficile Infection: A Single-Center Before-and-After Quality Improvement Intervention at a Tertiary-Care Medical Center

Cited by 17 publications

References 26 publications

Choosing an appropriate probiotic product for your patient: An evidence-based practical guide

Choosing an appropriate probiotic product for your patient: An evidence-based practical guide

Perils and pitfalls of probiotic quasi-experimental studies for primary prevention of Clostridioides difficile infection: A review of the evidence

Going back to prospectively collected results with a probiotic for primary prevention of Clostridium difficile infection at a tertiary-care medical center

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