Is there a future for probiotics in preventing Clostridium difficile-associated disease and treatment of recurrent episodes?

Due to morbidity, mortality, and high costs associated with eradicating Clostridium difficile once this organism causes colitis, this bacterium has been termed one of the most ecologically relevant microorganisms of the present day. Symptoms associated with C. difficile diarrhea often first present during or shortly after a course of antibiotic therapy. During the past 5 years, the virulence of this organism has increased. C. difficile-associated disease (CDAD) has reached epidemic proportions in some hospital settings, prompting Medicare to propose adding CDAD to the list of hospital-acquired conditions for which reimbursements may be cut. Thus, it is imperative that effective preventive strategies be implemented in hospitals to decrease CDAD infections. It is plausible that probiotic supplements may offer a safe and effective means of preventing both initial CDAD episodes as well as CDAD recurrences. This review critically examines the current literature in which probiotic supplements have been studied for efficacy in CDAD prevention. This analysis will guide practitioners in applying available probiotic data to CDAD clinical scenarios and will assist researchers in the appropriate design of future studies as examination continues into the role that probiotics may have in CDAD prevention.