Probiotics significantly reduce risk of infection with Clostridium difficile in hospitalized patients

Liz Meszaros, MDLinx

Digestive Disease Week® (DDW)

San Diego, California, United States | May 21-24, 2016


San Diego, CA, May 23, 2016—In hospitalized patients treated with antibiotics, the use of probiotics may significantly reduce the risk of Clostridium difficile infection (CDI), according researchers who presented results from a meta-analysis here at Digestive Disease Week 2016. They added that while no further studies are necessary to establish the efficacy of probiotics, further studies are needed to identify the optimal doses and strains to use.

Take-home messages

  • The risk of Clostridium difficile infection in hospitalized patients treated with antibiotics may be significantly reduced with the use of probiotics.
  • The most effective probiotics included Lactobacillus acidophilus and Lactobacillus casei.

“If your patient meets these criteria, it may be worth considering giving them a probiotic if they are getting an antibiotic. We need to further investigate what exact dose and which probiotic to recommend, but we do think it’s something clinicians should consider,” said lead researcher Nicole T. Shen, MD, internal medicine, New York Presbyterian-Weill Cornell, New York, NY.

Dr. Shen and colleagues conducted this systematic review and meta-analysis, searching Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, and references of relevant articles for randomized, controlled trials of subjects aged > 18 who were hospitalized and taking antibiotics and either a probiotic or placebo to evaluate for CDI. The primary outcome was efficacy of probiotics in the prevention of CDI.

They identified 18 studies, which included 6,129 subjects, and found that CDI incidence was significantly less in probiotic-treated patients (n=3,219) compared with controls (n=2,910)(1.6% vs 3.9%, respectively; P=0.003), for an absolute risk reduction of 2.3%, and a number needed to treat of 43.

Upon cumulative meta-analysis, Dr. Shen and fellow researchers found robust efficacy of probiotics in the prevention of CD (RR: 0.38; 95% CI: 0.27, 0.54; P ≤ 0.000, I2: 7.1%).

They also performed a pre-specified subgroup analysis, and found seven studies at low risk for bias with a summary statistic of 0.36 (95% CI: 0.23, 0.58, I2-30%). No specific species and strains were shown to have statistically significant differences in efficacy upon subgroup analysis (P=0.13), and researchers noted that this was perhaps caused by the limitations presented by the heterogeneity of probiotics used in the studies.

Of the nine different probiotics that were used, two studies using Lactobacillus acidophilus and Lactobacillus casei were the most effective (RR: 0.17; 95% CI: 0.08, 0.37; P ≤ 0.000, I2=0). Differences in formulation did not reach statistical significance, and an unadjusted meta-regression analysis showed no dose response. Finally, they found no reports of probiotic sepsis in any study.

Figure 2. Funnel plot.

Dr. Shen added that she also conducted a cost-effectiveness analysis with these data.

“We also found that probiotic use was suggested to be cost effective in patients ≥ 65 years old, but not cost effective in younger cohorts because of their lower risk for CDI and their lower outcomes from it,” she concluded.