Is There a Future for Probiotics in Preventing Clostridium difficile–Associated Disease and Treatment of Recurrent Episodes?

Abstract

Due to morbidity, mortality, and high costs associated with eradicating Clostridium difficile once this organism causes colitis, this bacterium has been termed one of the most ecologically relevant microorganisms of the present day. Symptoms associated with C. difficile diarrhea often first present during or shortly after a course of antibiotic therapy. During the past 5 years, the virulence of this organism has increased. C. difficile-associated disease (CDAD) has reached epidemic proportions in some hospital settings, prompting Medicare to propose adding CDAD to the list of hospital-acquired conditions for which reimbursements may be cut. Thus, it is imperative that effective preventive strategies be implemented in hospitals to decrease CDAD infections. It is plausible that probiotic supplements may offer a safe and effective means of preventing both initial CDAD episodes as well as CDAD recurrences. This review critically examines the current literature in which probiotic supplements have been studied for efficacy in CDAD prevention. This analysis will guide practitioners in applying available probiotic data to CDAD clinical scenarios and will assist researchers in the appropriate design of future studies as examination continues into the role that probiotics may have in CDAD prevention.

Fecal transplantation for the treatment of recurrentClostridium difficileinfection

“…The use of probiotics is conflicting,[242526] Saccharomyces boulardii has been found to decrease the recurrence rate of CDI by 30-33% when is used with antibiotics. [26] Toxin-binding agents such as tolevamer was also found to reduce the recurrence of CDI by 20-24% compared to standard antibiotics, however, it was not as effective as metronidazole or vancomycin in treating the primary episode of CDI (46% vs. 76-81%, respectively).…”

Microbial Metabolomics

“…The disruption of microbiota, such as caused by antibiotic treatment, can lead to dysregulation of host immune system and increase susceptibility to disease [76]. One notable example is antibiotic-associated diarrhea caused by the proliferation of Clostridium difficile resulting in pseudomembranous colitis, a health concern especially in hospitals and nursing home facilities [78, 79]. Additional abnormalities associated with gut microbiota have been demonstrated in mouse models; these include allergies, arthritis and central nervous system inflammation [74].…”

“…In general, species of Lactobacillus and Bifidobacterium are model organisms frequently utilized to show efficacy [72, 78, 79]. The recent advancement in genomics provides further insights into how probiotic bacteria react to the gastrointestinal tract environment.…”

Probiotics for Preventive Health

“…Issues related to preventing antibiotic-induced diarrhea 65 and recurrent Clostridium difficile colitis 66 were discussed in the previous issue. 67,68 Preventing Acute Diarrhea Sazawal et al 69 performed a meta-analysis to evaluate the evidence for the use of probiotics in the prevention of acute diarrhea. The meta-analysis included 34 masked, randomized, placebo-controlled trials.…”