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Lewis et al (2009) The potential of probiotic fermented milk products in reducing risk of antibiotic-associated diarrhoea and Clostridium difficile disease

Lewis et al (2009) The potential of probiotic fermented milk products in reducing risk of antibiotic-associated diarrhoea and Clostridium difficile disease

Citation

Lewis JN, Thomas LVand Weir W (2009). The potential of probiotic fermented milk products in reducing risk of antibiotic-associated diarrhoea and Clostridium difficile disease. International Journal of Dairy Technology 62 (4): 461-471.

Objective

This review includes a description of a hospital study with the probiotic LcS, presented at the Topics in Infection XXXV conference (Barts & the London), 30th January 2009: Weir W. Prevention of C difficile Related Disease with Prophylactic Probiotic.

The objective of this study was to assess the benefit of including a daily probiotic as part of an infection prevention strategy against Clostridium difficile in two hospitals in a UK NHS Trust.

Methods

An improved infection control policy to combat C. difficile was introduced, which included a revised antibiotic-prescribing policy, more focussed hygienic practices, and opening of an isolation ward. In addition, one daily serving of a probiotic drink (Yakult Light) was offered to all patients on four Care of the Elderly wards. Efficacy was assessed by routine monitoring of diarrhoea and laboratory confirmation of C. difficile.

Results

The combined infection prevention approach resulted in a clear drop in Trust-acquired C. difficile cases in both sites.

In the 26-month period before the probiotic was used, C. difficile cases averaged at 10.8 cases per month; in the subsequent 27-month period (after introduction of the probiotic and the isolation ward), this dropped to 3.4 cases per month. The probiotic was then offered to all patients over 65 years in all the Trust’s hospitals, irrespective of their ward. Over the next 12-months, C. difficile illness dropped to an average of 1.4 cases/month.

Before introduction of the probiotic and isolation ward, there were 71% more cases in the elderly compared to younger patients. After introduction of the probiotic, this changed to 18% more elderly cases compared to young. All other infection prevention measures affected all patients, regardless of their age and there was no increase in cases in younger patients. This observation was taken as further evidence of the probiotic reducing the susceptibility of the elderly to the infection, by improving their gut colonisation resistance ability.

Examination of the data on C. difficile for Trusts across England who had also previously reported 100-200 cases over a prior 3 month period, showed that this NHS Trust achieved 90% reduction of cases, which was the greatest improvement shown by any of these Trusts. 

Conclusions

All patients over 65 years should be offered probiotic, irrespective of whether they are taking antibiotics.

 
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