Probiotic use not found to be an effective strategy for primary prevention of clostridioides difficile infection

1. The administration of probiotics to high-risk inpatients receiving antibiotics identified by computerized clinical decision support was not shown to decrease the incidence of Clostridioides difficile infection.

Evidence Level Rating: 2 (Good)

Clostridioides difficile infection (CDI) is prevalent in the U.S. and produces substantial morbidity and mortality. Meta-analyses have suggested that the ingestion of probiotics during antibiotic therapy helps reduce the risk of CDI. This study evaluated the efficacy of using computerized clinical decision support (CCDS) at a large health care facility to reduce the risk of CDI by identifying high-risk patients who might benefit from primary prevention with probiotics. Patients were analyzed during a 13-month baseline period and a subsequent 13-month intervention period. Hospital-onset CDI before and after the probiotic intervention was assessed, as was a patient-level analysis among patients in the post-intervention cohort, examining CDI risk between patients who received probiotics compared with those who did not. In the hospital-level analysis, there was shown to be a pre-intervention decrease in CDI with a significant immediate decrease, but followed by a gradual increase, post-intervention (change in slope 1.4 per 10,000 patient days, p = 0.001). In the patient-level analysis, 132 and 153 patients had CDI in the pre- and post-intervention cohorts, respectively, corresponding to a 1.4-fold increased risk of CDI (95% CI 1.13 to 1.84, p = 0.003) in the post-intervention cohort after controlling for confounders. Finally, patients in receipt of probiotics were not shown to have lower rates of CDI compared with those who did not receive probiotics (OR 1.46, 95% CI 0.87 to 2.45). In all, CCDS-facilitated probiotic use for the primary prevention of CDI was not found to be effective in this cohort, with higher rates of CDI seen in the post-intervention period as well as a higher, though not significant, risk of CDI among patients receiving probiotics.

Click to read the study in CID

Image: PD

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