Pharmacy-led probiotic protocol reduces C Diff infection rates in a hospital setting

Pharmacy-led probiotic protocol reduces C Diff infection rates in a hospital setting

Patients taking high-risk antibiotics and a probiotic capsule had a lower risk of health care-associated C diff infections.

Multiple use of antibiotics can increase the risk of development Clostridium difficile infection in a hospital setting. Efforts to minimize these risks have focused on 2 strategies: first, to minimize exposure to pathogens and, second, to minimize susceptibility to infections. Probiotics can, according to research published in Clinical Infectious Diseases1 “offer another complementary approach and aim to improve the patient’s defenses [C diff infection]. “

Beginning in 2017, a Montreal hospital began administering a strain 3 Lactobacillus probiotics to hospitalized adult patients who take antibiotics in an effort to reduce associated health care rates C dis infections. Inpatient adult patients, including those in palliative and intensive care, who were prescribed 2 or more days of antibiotics received the probiotic every day within the first 24 hours of antibiotic use; Those aged 49 and younger took 1 capsule, while those aged 50 and over took 2 capsules. Probiotic capsules included Lactobacillus acidophilus CLI285, Lacticaseibacillus (Lactobacillus) casei LBC80R and Lacticaseibacillus (Lactobacillus) rhamnosus CLR2 (Bio-K + 50 billion) for the duration of the course of antibiotic treatment and for 5 days after the end of the antibiotic treatment.

Electronic health records for all antibiotic or probiotic prescriptions administered to hospitalized adult patients were evaluated between 2016 and 2019. Those who had 3 or more loose stools a day or who showed signs of possible C dis infection was asked to provide stool samples.

All associated with health care C dis Infections that occurred more than 48 hours after hospital admission or within 4 weeks of hospital discharge were reported to a provincial surveillance program. Recurrence of infection was defined as clinical symptoms of C dis emerging within 8 weeks of discharge.

A total of 13,922 electronic health records were identified in which antibiotics were prescribed, for a total of 4,383 unique patients over a 12-month observation period and 6079 patients over an 18-month intervention period (age ≥70 n = 2,142 and 2995 during each period, respectively). During the intervention period, quinolones were prescribed less frequently than during the observation period (odds ratio [OR]0.59), while an opposite trend was noted for third generation cephalosporins (OR, 2.1).

During the intervention period, a higher number of antibiotics prescribed per visit was also detected: 1.98 vs 1.94 (P. = .009). Investigators also found a higher proportion of patients taking an antibiotic that “historically represents a high risk of developing [C diff infection] during surgery “.

During the intervention period, hospital-associated health care throughout the entire hospital C dis the infection rate was “significantly lower” than the observation period (5.2 vs 8.6 cases per 10,000 patient-days, respectively). The proportion of infections with relapses was stable (19% vs 16% during the observation and intervention periods, respectively) and a smaller percentage of patients treated with probiotics experienced relapses (13% vs 26% during the observation period).

During the intervention period, the hospital pharmacy purchased and distributed 122,0000 probiotic capsules to 4,543 adult patients eligible for 70% of hospitalizations. These capsules were “generally well tolerated” with no cases of Lactobacillus bacteremia following the use of probiotics.

Investigators noted a potential selection bias “towards probiotic use in the elderly and those with increased antibiotic burden.” Most of those who received the probiotic (54%) were 70 years of age or older and received probiotics more frequently (OR, 2.0; 95% CI, 1.8-2.3). Probiotics were also administered more frequently in patients using quinolones, third generation cephalosporins, or carbapenems. These patients also received more antibiotics per visit than those who did not receive the probiotic.

Health care incidence C dis infections in patients taking antibiotics significantly decreased during surgery compared to the observation period (0.9% vs 1.5%, respectively). When riskier courses of antibiotics were prescribed, those in the probiotic group “fared better.”

“We found that using a pharmacy-led protocol made it possible to safely implement this probiotic in addition to antibiotics,” the researchers wrote. “The rate in the whole hospital of [health care-associated C diff infection] improved by 39% during surgery compared to the observation period, consistent with results from other hospitals implementing this probiotic.

“Experience … confirms the effectiveness of this probiotic preparation for primary prevention [health care-associated C diff infection]as described in multiple controlled clinical trials, ”they concluded.

Disclosures: Multiple authors report a relationship with Bio-K Plus International.


  1. Maziade PJ, Nave N, Sniffen JC, Goldstien EJC. Improved Clostridioides difficile infection prevention with a pharmacy controlled policy adding a 3 Lactobacillus probiotics in conjunction with antibiotic therapy. Clin Infect Dis. 2021; 73 (8): 1524-1527. doi: 10.1093 / cid / ciab414


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