Probiotics for the prevention of Clostridium difficile-associated diarrhea: A systematic review and meta-analysis

The Hospital for Sick Children Research Institute, Room 2420, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Annals of internal medicine (Impact Factor: 17.81). 12/2012; 157(12):878-88.
Source: PubMed


Antibiotic treatment may disturb the resistance of gastrointestinal flora to colonization. This may result in complications, the most serious of which is Clostridium difficile–associated diarrhea (CDAD).
To assess the efficacy and safety of probiotics for the prevention of CDAD in adults and children receiving antibiotics.
Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and 12 gray-literature sources.
Randomized, controlled trials including adult or pediatric patients receiving antibiotics that compared any strain or dose of a specified probiotic with placebo or with no treatment control and reported the incidence of CDAD.
Two reviewers independently screened potentially eligible articles; extracted data on populations, interventions, and outcomes; and assessed risk of bias. The Grading of Recommendations Assessment, Development and Evaluation guidelines were used to independently rate overall confidence in effect estimates for each outcome.
Twenty trials including 3818 participants met the eligibility criteria. Probiotics reduced the incidence of CDAD by 66% (pooled relative risk, 0.34 [95% CI, 0.24 to 0.49]; I(2) = 0%). In a population with a 5% incidence of antibiotic-associated CDAD (median control group risk), probiotic prophylaxis would prevent 33 episodes (CI, 25 to 38 episodes) per 1000 persons. Of probiotic-treated patients, 9.3% experienced adverse events, compared with 12.6% of control patients (relative risk, 0.82 [CI, 0.65 to 1.05]; I(2) = 17%).
In 13 trials, data on CDAD were missing for 5% to 45% of patients. The results were robust to worst-plausible assumptions regarding event rates in studies with missing outcome data.
Moderate-quality evidence suggests that probiotic prophylaxis results in a large reduction in CDAD without an increase in clinically important adverse events.

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    • "Recent meta-analysis on CDI treatment successes (Johnston et al., 2012) in faecal transplantation in CDI therapy (Brandt, 2012; Van Nood et al., 2013) and this case series shows that even in patients at high risk, with multiple severe underlying diseases, administration of multistrain probiotics might be beneficial by shortening the diseases course as well as by preventing further relapses in patients with recurrent CDI. "
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    DESCRIPTION: Probiotics in Clostridium difficile infection: reviewing the need for a multistrain probiotic
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    • "Treatment for a second or later recurrence includes a tapered or long-term vancomycin. Due to high recurrence rates and alteration of colonic microbiota with the continued use of antimicrobial drugs, new approaches in therapy include new narrow-spectrum antibiotics, probiotics, and monoclonal antibodies [10] [11] [14] [15]. "
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    ABSTRACT: Clostridium difficile infection is one of the most common nosocomial infections. Among other alternatives to standard treatment with vancomycin for recurrent infection are faecal microbiota transplantation and rectal bacteriotherapy with a fixed mixture of intestinal bacterial strains isolated from faeces of healthy persons to mimic a theoretical normal microflora. Developed by Dr. Tvede and Dr. Rask-Madsen, the latter method has been in use for selected patients during the last 25 years in Denmark. In this study we reviewed the medical records of patients treated with rectal bacteriotherapy for relapsing C. difficile in Denmark, 2000-2012. The primary end point was recurrent diarrhoea within 30 days after treatment. A total of 55 patients were included in this case series. Thirty-five patients (64%) had no recurrence within 30 days of bacteriotherapy. Patients with recurrence tended to be older (75.8 years vs. 61.3 years; p 0.26), and more often have preexisting gastrointestinal illness and longer duration of time from the first CDI to bacteriotherapy (221.6 days vs. 175.3 days; p 0.18). Treatment success was 80% in the subgroup of patients with no known gastrointestinal illness and first C. difficile episode less than 6 months before bacteriotherapy. The most common adverse events were abdominal pain (10.9%) and worsening diarrhoea (4.3%). One patient was hospitalized 10 days after treatment with appendicitis, fever, and Escherichia coli bacteremia. The results from this study indicate that rectal bacteriotherapy is a viable alternative to faecal microbiota transplantation in patients with relapsing C. difficile-associated diarrhoea. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    Clinical Microbiology and Infection 01/2015; 21(1):48-53. DOI:10.1016/j.cmi.2014.07.003 · 5.77 Impact Factor
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    • "The probiotic strains that have been reported as clinically useful include, Lactobacillus rhamnosus GG, various other Lactobacilli and Bifidobacteria strains and the yeast Saccharomyces boulardii (Hickson, 2011). The various species of probiotics that have been clinically investigated differ from studies with single strains (e.g., Saccharomyces boulardii, Lactobacillus rhamnosus GG, Bacillus clausii, Bifidobacterium longum, Clostridium butyricum miyairir, Lactobacillus acidophilus, Enterococcus faecium SF68), to studies with mixtures of two or more species of probiotics, or to a synbiotic [probiotic(s) combined with a prebiotic constituent (e.g., inulin)] (Hickson, 2011). As an example a recent meta-analysis reported the administration of probiotics for the prevention of Clostridium Difficile Associated Diarrhea (CDAD) (Johnston et al., 2012). "
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    ABSTRACT: Bacteria comprise the earliest form of independent life on this planet. Bacterial development has included co–operative symbiosis with plants (e.g., Leguminosae family and nitrogen fixing bacteria in soil) and animals (e.g., the gut microbiome). A fusion event of two prokaryotes evolutionarily gave rise to the eukaryote cell in which mitochondria may be envisaged as a genetically functional mosaic, a relic from one of the prokaryote cells. The discovery of bacterial inhibitors such chloramphenicol and others has been exploited to highlight mitochondria as arising from a bacterial progenitor. As such the evolution of human life has been complexly connected to bacterial activity. This is embodied, by the appearance of mitochondria in eukaryotes (alphaproteobacteria contribution), a significant endosymbiotic evolutionary event. During the twentieth century there was an increasing dependency on anti–microbials as mainline therapy against bacterial infections. It is only comparatively recently that the essential roles played by the gastrointestinal tract (GIT) microbiome in animal health and development has been recognized as opposed to the GIT microbiome being a toxic collection of micro–organisms. It is now well documented that t
    Frontiers in Cellular and Infection Microbiology 10/2014; 4:143. DOI:10.3389/fcimb.2014.00143 · 3.72 Impact Factor
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