Probiotics for the Prevention of CDAD: an idea to flush down the toilet?

Abstract

Background: With an aging population, the majority of patients in hospitals tend to be over 50 years old. Clostridium difficile, an opportunistic pathogen, is the culprit in a very common condition amongst these older patients, especially in a hospital setting, as a result of the use of broad spectrum antibiotics. This condition is called Clostridium difficile-associated diarrhea (CDAD). Literature confirms that about 25% of all antibiotics-associated diarrhea (AAD) are the result of an infection by C. difficile, which has a high mortality rate and an increase in the duration of hospitalization. Probiotics are commonly used to prevent diarrhea and restore intestinal flora to its healthy state. Research question: Is the use of probiotics effective as a preventive measure for CDAD in hospitalized individuals over the age of 50? Objective: We conducted a literature review in order to determine if the administration of probiotics will help reduce the incidence rate of CDAD in adult patients over 50 years of age. Methods: Two databases were used, PubMed and SCOPUS, to conduct our literature search. The keywords used were: “probiotics”, “prevention”, “clostridium difficile”, “hospital” and “adults”. A total of 49 results were obtained. Articles included had to be in English or French, based on a human population aged 50 or over, not published before the year 2006, peer-reviewed, accessible and had to address CDAD and not just AAD. The articles were also screened for relevance. Upon the application of our relevance criteria, 6 articles were deemed pertinent. Results: Of the 6 relevant articles found, 3 demonstrate a reduction in the incidence of CDAD in hospitals through the use of probiotics, 2 others fail to do so while 1 has inconclusive results. Conclusion: The literature is divided in the effectiveness of probiotics as a preventative measure for CDAD. Further studies are needed.