Abstract
Objectives
Clostridioides difficile infection (CDI) is a leading cause of antimicrobial-associated colitis and is a global
clinical concern. Probiotics are considered a CDI-preventive measure; however, highly
inconsistent data have been previously reported. Thus, we evaluated the CDI-preventive
effect of prescribed probiotics in high-risk older patients receiving antibiotics.
Methods
Older patients (aged ≥65 years) admitted to the emergency department who received
antibiotics between 2014 and 2017 were enrolled in this single-center retrospective
cohort study. Propensity score-matched analysis was used to compare the CDI incidence
in patients who took the prescribed probiotics within 2 days of receiving antibiotics
for at least 7 days with those who did not. The rates of severe CDI and associated
hospital mortality were also evaluated.
Results
Among 6148 eligible patients, 221 were included in the prescribed probiotic group.
A propensity score-matched (221 matched pairs) well-balanced for patient characteristics
was obtained. The incidence of primary nosocomial CDI did not differ significantly
between the prescribed and non-prescribed probiotic groups (0% [0/221] vs. 1.0% [2/221],
p = 0.156). Of the 6148 eligible patients, 0.5% (30/6148) developed CDI, with a severe
CDI rate of 33.3% (10/30). Furthermore, no CDI-associated in-hospital mortality was
observed in the study cohort.
Conclusions
The evidence from this study does not support recommendations for the routine use
of prescribed probiotics to prevent primary CDI in older patients receiving antibiotics in situations where the CDI is infrequent.
Keywords
Abbreviations:
CDI (Clostridioides difficile infection), CI (confidence interval), GDH (glutamate dehydrogenase), IDSA (Infectious Diseases Society of America), SHEA (Society for Health Epidemiology of America), IQR (interquartile range), PPI (proton pump inhibitor)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 23, 2023
Accepted:
May 2,
2023
Received in revised form:
March 29,
2023
Received:
January 7,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
