Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis

Shen, Nicole T.; Maw, Anna; Tmanova, Lyubov L.; Pino, Alejandro; Ancy, Kayley M.; Crawford, Carl V.; Simon, Matthew S.; Evans, Arthur T.

doi:10.1053/j.gastro.2017.02.003

Cited by 236 publications

(173 citation statements)

References 43 publications

(64 reference statements)

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“…Typical risk factors for fungaemia are the use of central venous catheters, enteral or parenteral nutrition, being treated in an intensive care unit, and immunosuppression. In a metaanalysis by Shen et al 21 investigating the use of probiotics in C. difficile infections, 538 patients received S. boulardii. No fungaemia was reported.…”

Section: Discussionmentioning

confidence: 99%

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Design of the GutHeart—targeting gut microbiota to treat heart failure—trial: a Phase II, randomized clinical trial

et al. 2018

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AimsHeart failure (HF) is a multifactorial disease. Current treatments target only a fraction of the putative pathophysiological pathways. In patients with HF, reduced cardiac output and congestion cause increased gut wall permeability. It has been suggested that leakage of microbial products is detrimental to the heart, at least partly through activation of systemic inflammatory pathways, which again could promote gut leakage. Whether manipulating the gut microbiota can improve cardiac function in patients with HF remains unknown. We aim to evaluate the effect of drugs targeting the gut microbiota on left ventricular function, quality of life, and functional capacity, as well as on markers of gut leakage and inflammation, in stable patients with HF with reduced ejection fraction.Methods and resultsGutHeart is a randomized, open‐label, controlled trial. Four centres will randomize 150 patients with stable HF and a left ventricular ejection fraction <40% to receive the antibiotic rifaximin, the probiotic yeast Saccharomyces boulardii (ATCC 74012), or no treatment (control) in a 1:1:1 fashion. Treatment will last for 3 months. The primary endpoint is baseline‐adjusted left ventricular ejection fraction as measured by echocardiography after 3 months. A further follow‐up 6 months after randomization will be undertaken.ConclusionsThis trial is likely to give new insights into important disease processes involving the gut microbiota in HF patients, hereby leading to new potential therapeutic strategies to prevent and down‐regulate the inflammation seen in these patients.

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Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only limited data exist on the use of S. boulardii in HF populations; thus, we will remain vigilant in reporting adverse events. 21 Rifaximin was chosen for its local effects in the gut and its low absorption. It is a non-absorbable antibiotic with minimal systemic effects.…”

Section: Discussionmentioning

confidence: 99%

Design of the GutHeart—targeting gut microbiota to treat heart failure—trial: a Phase II, randomized clinical trial

et al. 2018

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“…Use of probiotics might be helpful in primary prevention 4142. However, US guidelines do not recommend their use outside clinical trials because of insufficient data 6…”

Section: How Can We Reduce the Risk Of C Difficile Infection?mentioning

confidence: 99%

Clostridium difficile associated disease

Hassoun

2018

BMJ

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“…Fidaxomicin is an effective treatment option for first or second CDI episodes and has been associated with a reduced rate of relapse compared to oral vancomycin, but it does not appear to be any more effective for patients with recurrent CDI . The use of probiotics has been controversial, where some controlled trials show benefit and others do not . Probiotics lack U.S. Food and Drug Administration (FDA)‐approved indications for CDI, and the term “probiotics” encompasses several different available products with varying degrees of efficacy .…”

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confidence: 99%

Bezlotoxumab: A Novel Agent for the Prevention of Recurrent Clostridium difficile Infection

et al. 2017

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During the past decade, the incidence and severity of Clostridium difficile infection (CDI) have significantly increased, leading to a rise in CDI-associated hospitalizations, health care costs, and mortality. Although treatment options exist for CDI, recurrence is frequent following treatment. Furthermore, patients with at least one CDI recurrence are at an increased risk of developing additional recurrences. A novel approach to the prevention of recurrent CDI is the use of monoclonal antibodies directed against the toxins responsible for CDI as an adjunct to antibiotic treatment. Bezlotoxumab, a human monoclonal antibody that binds and neutralizes C. difficile toxin B, is the first therapeutic agent to receive United States Food and Drug Administration approval for the prevention of CDI recurrence. Clinical studies have demonstrated superior efficacy of bezlotoxumab in adults receiving antibiotic therapy for CDI compared with antibiotic therapy alone for the prevention of CDI recurrence. Bezlotoxumab was well tolerated in clinical trials, with the most common adverse effects being nausea, vomiting, fatigue, pyrexia, headache, and diarrhea. The demonstrated efficacy, safety, and characteristics of bezlotoxumab present an advance in prevention of CDI recurrence.

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Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis

Cited by 236 publications

References 43 publications

Design of the GutHeart—targeting gut microbiota to treat heart failure—trial: a Phase II, randomized clinical trial

Design of the GutHeart—targeting gut microbiota to treat heart failure—trial: a Phase II, randomized clinical trial

Clostridium difficile associated disease

Bezlotoxumab: A Novel Agent for the Prevention of Recurrent Clostridium difficile Infection

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