Does Probiotic Use Protect Against Clostridioides difficile Infections in Patients Taking Antibiotics?Investigators: Brittany Baskett, Kaitlyn Ledet, Melanie Rae Schrack
Practice Site: FMOL Health - Our Lady of the Lake
Email: [email protected]Purpose: Patients on prolonged antibiotics are at increased risk of contracting a
Clostridioides difficile infection (CDI). The 2017 Infectious Disease Society of America and Society for Healthcare Epidemiology of America guideline for management of CDI stated there is insufficient data to recommend administration of probiotics for primary prevention of CDIs outside of clinical trials, while the 2021 American College of Gastroenterology guideline for management of CDI recommends against prophylactic probiotic use. Recently published data in critically ill patients indicate that probiotics used for CDI prevention during antibiotic therapy may increase the risk of probiotic-related bacteremia. Given a recent rise in probiotic prescribing at this site for primary CDI prevention, this study aimed to evaluate whether probiotics reduce CDI risk in patients receiving antibiotics for five or more days without increasing bacteremia risk.
Methods: This study was a single-center, retrospective chart review of patients admitted to any intensive care or progressive care unit at FMOL Health – Our Lady of the Lake from January 2024 to December 2024. Patients were excluded from data analysis if they were less than 18 years of age, received an antibiotic regimen including less than two antibiotics, antibiotic regimen less than five days or greater than 30 days, had infectious diarrhea of other causes, or a history of pre-existing gastrointestinal disorders. Included patients were split into two groups: receipt of antibiotics without probiotics and receipt of antibiotics with three or more days of concurrent probiotic administration.
The primary outcome was the incidence of hospital-acquired CDI. HA-CDI (hospital-acquired CDI) was defined as a positive
C. difficile antigen and toxin test after 72 hours of admission to the hospital. Secondary outcomes included incidence of
Lactobacillus bacteremia and percent days covered by probiotics.
Results: A total of 441 patients were included in this study with 147 patients in the probiotic group and 294 patients in the control group. In the control group, one patient (0.3%) was diagnosed with HA-CDI, while five patients (3.4%) in the probiotic group were diagnosed with HA-CDI. There were no incidences of
Lactobacillus bacteremia. Average percentage of probiotic coverage was 68% of antibiotic days in the probiotic group.
Conclusion: Among critically ill patients requiring at least two antibiotics for at least five days, there was a difference between groups with HA-CDI occurring more often in the probiotic group. This study supports guideline statements that there is not a widely recognized benefit to prescription of probiotics for prevention of CDI; however, there was no demonstrated harm found in this study.
