Probiotics Prevent C. difficile Infection in Hospitalized Adults

Despite positive results of prior systematic reviews for the efficacy of probiotics in preventing Clostridium difficile infection in hospitalized patients, current guidelines do not recommend their use in this setting.

In a systematic review of probiotic use in hospitalized patients to prevent C. difficile infection in patients started on antibiotics, 19 randomized trials were identified, including 3277 patients randomized to probiotic intervention and 2984 to placebo. Results of a meta-analysis of these data were as follows:

• Overall, the incidence of C. difficile infection was lower in probiotic users than in controls (1.6% vs. 3.9%; pooled relative risk with probiotic use, 0.42).

• The protective effect of probiotics was lower if started >2 days after antibiotic initiation versus within 2 days (relative risk, 0.70 vs. 0.32).

• Meta-regression showed an 18% decline in benefit for every day of delay in starting probiotics.

• There was no increase in adverse effects with probiotics.

• There were nonsignificant trends toward better protection with a few specific probiotic formulations, including Lactobacillus and Lactobacillus in combination with either Streptococcus or both Bifidobacterium and Streptococcus.