Patients taking high-risk antibiotics and a probiotic capsule had a lower risk of healthcare-associated C diff infections.
Multiple use of antibiotics may increase the risk of development Clostridium difficile infection in a hospital setting. Efforts to minimize these risks have focused on two strategies: first, minimizing exposure to pathogens, and second, minimizing susceptibility to infection. Probiotics can, according to research published in Clinical infectious diseases,1″ offers another complementary approach aimed at improving a patient’s defenses to [C diff infection]†
As of 2017, a Montreal hospital began administering a 3 strain Lactobacillus probiotics for adult hospitalized patients taking antibiotics in an effort to reduce the number of healthcare-related patients C difference infections. Adult inpatients – including patients in the palliative and intensive care units – who were prescribed antibiotics for 2 or more days were given the probiotic daily within the first 24 hours of antibiotic use; those aged 49 or younger took 1 capsule, while those aged 50 or older took 2 capsules. Probiotic capsules included Lactobacillus acidophilus CLI285, Lacticaseibacillus (Lactobacillus) casei LBC80R, and Lacticaseibacillus (Lactobacillus) rhamnosus CLR2 (Bio-K+ 50 billion) for the duration of their antibiotic course and for 5 days after antibiotic treatment was completed.
Between 2016 and 2019, electronic pharmacy records were evaluated for all antibiotics or probiotic prescriptions administered to adult hospitalized patients. Those who had 3 or more loose stools per day, or who showed signs of possible C difference infection were asked to provide stool samples.
All healthcare related C difference infections occurring more than 48 hours after hospitalization or within 4 weeks of hospital discharge were reported to a provincial surveillance program. Recurrence of infection was defined as clinical signs of C difference appear within 8 weeks of discharge.
A total of 13,922 electronic pharmacy records were identified in which antibiotics were prescribed, for a total of 4383 unique patients during a 12-month observation period and 6,079 patients during an 18-month intervention period (age ≥70 n=2142 and 2995 during each period, respectively). During the intervention period, quinolones were prescribed less often than in the observation period (odds ratio [OR]0.59), while an opposite trend was noted for third generation cephalosporins (OR, 2.1).
A higher number of antibiotics per visit was also prescribed during the intervention period: 1.98 versus 1.94 (p =.009). Researchers also saw that a greater number of patients took an antibiotic that “traditionally carries a high risk for the development of” [C diff infection] during the intervention.”
During the intervention period, hospital-wide care-related C difference infection rate was “significantly lower” compared to the observation period (5.2 vs. 8.6 cases per 10,000 patient days, respectively). The proportion of infections with recurrences was stable (19% vs. 16% during the observation and intervention period, respectively) and a smaller proportion of probiotic-treated patients had relapses (13% vs. 26% during the observation period).
During the intervention period, the hospital pharmacy purchased and dispensed 122,000 probiotic capsules to 4,543 eligible adult patients for 70% of hospital admissions. These capsules were “generally well tolerated”, with no cases of Lactobacillus bacteremia after taking probiotics.
Researchers noted a possible selection bias “toward the use of the probiotic in older adults and those with an increased antibiotic load.” A majority of those receiving the probiotic (54%) were 70 years or older and were more likely to receive probiotics (OR 2.0; 95% CI 1.8-2.3). Probiotics were also administered more frequently to patients taking quinolones, third-generation cephalosporin, or carbapenems. These patients also received more antibiotics per visit compared to those who did not receive the probiotic.
Incidences of healthcare-related C difference infections in patients taking antibiotics decreased significantly during the intervention versus the observation period (0.9% versus 1.5%), respectively. When riskier antibiotics were prescribed, those in the probiotic group did ‘better’.
“We found that using a pharmacy-driven protocol made it possible to safely implement this probiotic as an adjunct to antibiotics,” the researchers wrote. “The hospital-wide rate of [health care-associated C diff infection] improved by 39% during the intervention compared to the observation period, consistent with findings from other hospitals using this probiotic.”
“The experience … confirms the effectiveness of this probiotic preparation for the primary prevention of [health care-associated C diff infection]as described in multiple controlled clinical studies,” they concluded.
Disclosures: Multiple authors report association with Bio-K Plus International.
- Maziade PJ, Ship N, Sniffen JC, Goldstien EJC. Strengthens Clostridioides difficile infection prevention with a pharmacy-driven policy that adds a 3 strain Lactobacillus probiotics concomitantly with antibiotic therapy. Clin Infect Dis. 2021;73(8):1524-1527. doi:10.1093/cid/ciab414