Antibiotics are a crucial weapon in the fight against a wide variety of diseases. However, the common use of antibiotics has been shown to greatly increase the risk of Clostridium difficile infection (C. diff), a serious and potentially deadly disease that is a major cause of illness and death among hospitalized patients.
When antibiotics are taken to fight an infection, they wipe out the natural gut flora in the digestive tract, leaving room for an infection like C. diff to overgrow in the colon. The Centers for Disease Control and Prevention reports that C. diff nearly doubled between 2001 and 2010, so finding a way to prevent it — without stopping the appropriate use of antibiotics — is a significant challenge that we face in hospitals every day.
In search of this answer, my team and I at New York Presbyterian have looked towards probiotics as a possible solution and found that they can help prevent C. diff. Probiotics, the live bacteria and yeasts that are known to aid the digestive system, help restore the natural flora in the digestive system, potentially preventing C. diff from invading. We found conclusive evidence that the use of probiotics significantly reduces the risk of C. diff for the highest-risk group of patients — hospitalized, adult patients receiving antibiotics.
We'll be presenting our study in San Diego at Digestive Disease Week 2016, the world's largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery, and we believe the findings will help prevent hundreds of thousands of cases of this infection in the future.
You can read more specifics about our study here, but, based on our analysis, we believe for every 50 patients who develop C. diff while in the hospital, adding a probiotic would eliminate one case — a measure referred to as "number needed to treat." This is a relatively low number, considering that taking a probiotic is simple and relatively inexpensive, especially compared to the intensive treatment of C. diff. Additionally, the use of probiotics carries a low risk of side effects — and the result is potentially life-saving.
So, which probiotics were the most effective, you might be wondering? Among the nine different probiotics used in the studies we examined, we saw that several appeared to perform better than others in preventing C. diff, but the differences were not significant enough for us to recommend using one over the others. Significantly, probiotics given within two days of the antibiotic were found to be more effective than those given later.
That said, additional studies could provide insight on which probiotics might be better than others (and perhaps for various types of patients) and what the optimal dosage and timing should be.
Nicole Shen, MD, is currently a third year resident physician at New York Presbyterian Hospital ― Weill Cornell, where she is expected to continue her training as a fellow in gastroenterology and hepatology in July 2016. Her research interests include evidence-based medicine, cost-effective care delivery, access to care, and hepatology.
Dr. Shen will present data from the study "The use of probiotics for the prevention of Clostridium Difficile Infection (CDI) in hospitalized adults receiving antibiotics: a systematic review and meta-analysis," abstract 661, on Monday, May 23, at 2:45 p.m. PT, at the San Diego Convention Center. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit www.ddw.org/press.
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