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Pirker et al (2013) Effects of antibiotic therapy on the gastrointestinal microbiota and the influence of Lactobacillus casei

Pirker et al (2013) Effects of antibiotic therapy on the gastrointestinal microbiota and the influence of Lactobacillus casei

Citation

Pirker A, Stockenhuber A, Remely M, Harrant A, Hippe B, Kamhuber C, Adelmann K, Stokenhuber F, Haslberger AG (2013) Effects of antibiotic therapy on the gastrointestinal microbiota and the influence of Lactobacillus casei. Food & Agricultural Immunology 24(3):315-330.

Objective

To investigate the effect of daily probiotic (Lactobacillus casei Shirota, LcS) on the incidence of antibiotic-associated diarrhoea (AAD), Clostridium difficile infection (CDI) and the faecal microbiota.

Methods

The study was performed at a hospital in Austria, where elderly patients on specific wards were divided into two groups:
- Group AP  (n=340, mean age 71): on antibiotics and given one daily LcS drink during treatment and for 3 days after this finished. Antibiotics included penicillins, cephalosporins, quinolones, clindamycin and vancomycin. At the time of probiotic intake, all patients and staff on the ward were given probiotic.
 - Group A (n=338, mean age 69): on antibiotics but not given probiotic. No other patients or staff on the ward during this time were given probiotic.

Faecal samples were taken from a sub-group of 56 patients , and four groups were tested: those on antibiotic only (A); those on antibiotic + probiotic (AP); those on probiotic only (P); those on neither (C). Analysis was by means of C. difficile ELISA (678 patients), and the subgroup analyses comprised qPCR suign 16S rRNA group-specific primers, C. difficile toxin kit and PCR/denaturing gradient gel electrophoresis. 

Results

AAD developed in 5% (17/340) of the LcS (AP) group vs 18.6% (63/338) in control (A) group. This equated to a relative risk reduction with LcS of 73.2% (P less than 0.001).

CDI developed in 0.3% (1/340) of the LcS (AP) group vs 6.2% (21/338) in control (A) group. This equated to a relative risk reduction with LcS of 95.3% (P less than 0.001).

Antibiotic therapy was associated with an increase in Enterobacteriaceae and a decrease in abundance of total Bacteria, Clostridium cluster IV and XI, Bifidobacterium spp., and butyryl-CoA CoA transferase genes. LcS intervention reduced the AAD-associated decrease in microbial diversity and decrease in Bifidobacterium spp, and increased Lactobacillus abundance. 

Conclusions

Antibiotic treatment causes a change in microbiota and associated reduction in short chain fatty acid (butyrate) production. Probiotic Lactobacillus intervention prevent some of these changes.  The data indicate that AAD is significantly decreased with L. casei Shirota.  

 
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