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November 12, 2012

Probiotics show potential to minimize C. difficile in some hospital settings

Medical use of probiotics could be significant in minimizing C. difficile (Clostridium difficile) infection among hospitalized patients taking antibiotics, according to research from The Hospital for Sick Children (SickKids) and McMaster University. The study is published today in Annals of Internal Medicine.

The research team compiled findings from 20 randomized controlled trials including a total of 3818 patients. The trials tracked rates of probiotic use in inpatients and outpatients who were receiving antibiotics, and analyzed rates of diarrheal illness associated with C. difficile among the groups. Eighteen of the 20 trials studied were of inpatient and outpatient adults, while two studies were of children. Results were similar among these groups.

Overall, use of probiotics reduced the new cases of C. difficile-associated diarrhea among patients taking antibiotics by two thirds (66 per cent), with no serious adverse events attributable to probiotics. Projected onto current rates of C. difficile-associated diarrhea, this would reduce the rate of illness by approximately three patients per one hundred (or 33 per thousand) patients.

“Probiotics are not a magic bullet, but these results suggest that therapeutic probiotic agents, as well as some yogurts and probiotic dairy products, may be vastly under-used in some nursing homes and hospitals,” says lead author Dr. Bradley Johnston. He is a Scientist and Clinical Epidemiologist at SickKids and Assistant Professor of Health Policy, Management and Evaluation at University of Toronto.

Important public health issue

The risk of serious C. difficile infection appears primarily among older hospitalized adults who are exposed to antibiotics.

Up to half of all diarrheal illness in hospital is associated with this infection, which is a significant cause of illness and death in hospitalized adults. From 2009-2011 the Ontario Ministry of Health and Long-Term Care tracked 75 outbreaks in 47 hospitals. (Ontario hospitals report their rates of C. difficile infection at www.patientsafetyontario.net.)

“Minimizing or even preventing C. difficile among vulnerable patients is a high priority for making every hospital as safe as possible for all patients. It’s an important public health issue,” Dr. Johnston adds. He notes that a 2010 University of Ottawa study found that for every 10 patients who acquired C. difficile, one died of the infection.

Further study needed for debilitated children

Because immunocompromised and debilitated children are potentially at risk of systemic infection from probiotics, more research is needed regarding application of these results to children. “We applaud any effort to improve the prevention of C. difficile infection,” adds Dr. Upton Allen, infectious disease specialist at SickKids. “Although this study found no serious adverse events among the populations studied, we need further research into the significance of the results and the safety and efficacy of probiotics in children, notably those with weakened immune systems,” he says. Dr. Allen is Chief, Division of Infectious Diseases, and Senior Associate Scientist at SickKids, and Professor of Paediatrics and Health Policy, Management and Evaluation at the University of Toronto.

Reintroduce healthy bacteria

Probiotic powder and capsules as well as yogurt were included in the studies analyzed. “The results appeared to be even more pronounced when several probiotic organisms were used together,” says Dr. Johnston.

When broad-spectrum antibiotics are prescribed to treat and prevent infections the medications can also destroy necessary healthy bacteria in the colon. Probiotics help to reintroduce healthy bacteria. “That’s why probiotics could be an effective, safe and relatively inexpensive approach to prevent C. difficile-associated diarrheal illness in adult patients whose immune systems are not compromised,” adds Dr. Johnston.

“Because C. difficile forms spores, it is difficult to eradicate from the environment,” says co-author Dr. Mark Loeb. “Probiotics can be easily integrated into the diets of hospitalized patients.” Dr. Loeb is Professor of Pathology and Molecular Medicine and Division Director of Infectious Diseases at McMaster University.

About The Hospital for Sick Children
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision for Healthier Children. A Better World. For more information, please visit www.sickkids.ca.

About SickKids Centre for Research and Learning

The SickKids Centre for Research and Learning will bring together researchers from different scientific disciplines and a variety of clinical perspectives, to accelerate discoveries, new knowledge and their application to child health — a different concept from traditional research building designs. The facility will physically connect SickKids science, discovery and learning activities to its clinical operations. Designed by award-winning architects Diamond + Schmitt Inc. and HDR Inc. with a goal to achieve LEED® Gold Certification for sustainable design, the Centre will create an architectural landmark as the eastern gateway to Toronto’s Discovery District. The SickKids Centre for Research and Learning is funded by a grant from the Canada Foundation for Innovation, the Government of Ontario, philanthropist Peter Gilgan and community support for the ongoing fundraising campaign. For more information, please visit www.sickkidsfoundation.com/bepartofit.

About McMaster University

McMaster University, one of four Canadian universities listed among the Top 100 universities in the world, is renowned for its innovation in both learning and discovery. It has a student population of 23,000 and more than 156 alumni in 140 countries.

For more information, please contact:

Polly Thompson
The Hospital for Sick Children
Toronto, Ontario, Canada
Phone:  416-813-7654 ext. 2059
email: polly.thompson@sickkids.ca

Matet Nebres
The Hospital for Sick Children
Toronto, Ontario, Canada
Phone: 416-813-6380
email: matet.nebres@sickkids.ca

Veronica McGuire

McMaster University
Hamilton, Ontario, Canada
Phone: 905-525-9140 ext . 22169
email: vmcguir@mcmaster.ca