Probiotic Use May Not Protect Against Clostridium Difficile Infection

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The use of probiotics was associated with increased incidence of C difficile infection, especially in patients using multiple antibiotics, proton pump inhibitors, or histamine receptor antagonists.
The use of probiotics was associated with increased incidence of C difficile infection, especially in patients using multiple antibiotics, proton pump inhibitors, or histamine receptor antagonists.
This article is part of Infectious Disease Advisor's coverage of IDWeek 2018, taking place in San Francisco, CA. Our on-site staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from IDWeek 2018.

SAN FRANSISCO — In patients taking multiple antibiotics, proton pump inhibitors, or histamine receptor antagonists, the concurrent use of probiotics was associated with an increased incidence of Clostridium difficile infection, according to research presented at IDWeek 2018, held October 3-7, 2018, in San Francisco.

The researchers of this retrospective cohort study sought to evaluate whether administering probiotics was an effective approach for precluding C difficile infection. In addition, the study authors assessed which historic risk factors (antibiotic use, proton pump inhibitors, chemotherapy, and histamine receptor agonists) were associated with an increased incidence of C difficile infection. Researchers also conducted a literature review prior to study onset, which demonstrated that “the administration of probiotics closer to the first dose of antibiotics decreases the risk of C difficile infection by >50%.”

The study cohort included 1502 patients age >18 who received at least 1 dose of antibiotics at NYU Winthrop Hospital and were considered high risk for C difficile infection. Patients who had a recent incidence of C difficile infection, who were infected with another pathogen, or who started an antibiotic and/or probiotic regimen less than 24 hours after incident C difficile infection were excluded. Patient characteristics, including demographic information, C difficile infection course and treatment, antibiotic use, and probiotic use, were collected at baseline. After initiating antibiotics, the patients were tested for < 12 weeks for C difficile infection, and the study authors assessed the relative risk of inducing infection. Patients using probiotics were compared to patients with no probiotic regimen, and researchers used a logistic regression model to estimate the effect of probiotics on incident C difficile infection.

Of the 1502 patients receiving antibiotics, 135 (9%) used probiotics, and 1367 (91%) did not. A positive correlation was discovered between the number of high-risk antibiotics taken and the proportion of patients with concurrent probiotic use: 7% of patients taking 1 antibiotic also used probiotics; 17% of patients taking 2 antibiotics used probiotics; and 24% of patients taking 3 or more antibiotics used probiotics (P <.0001 for all). Within 12 weeks of initiating antibiotic use, 6% of the overall cohort tested positive for C difficile infection. Incidence of infection was 11.1% in the probiotic group and 5.9% in the no probiotic group, demonstrating that patients using concurrent probiotics have a relative risk (RR) of 1.88 (95% CI, 1.1-3.16; P =.02) compared to patients who did not take probiotics. With a logistic regression model, this risk was further associated with taking 2 concurrent antibiotics (RR 3.1; 95% CI, 1.82-5.25; P =.46), 3 or more concurrent antibiotics (RR 6.27; 95% CI, 3.13-12.68; P =.0003), proton pump inhibitors (RR 7.1; 95% CI, 4.32-11.67; P <.0001), and histamine receptor antagonists (RR 5.49; 95% CI, 3.26-9.20; P <.0001).

The use of probiotics was associated with increased incidence of C difficile infection, especially in patients using multiple antibiotics, proton pump inhibitors, or histamine receptor antagonists. The study authors suggested the results of this study indicate a lack of support for the use of probiotics to prevent C difficile infection.

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Reference

Saltzman T, Fazzari M, Chung S, Cunha BA, Blum S. The effect of probiotics on the incidence of Clostridium difficile. Poster presentation at: IDWeek 2018; October 3-7, 2018; San Francisco, CA. Poster 514.

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