1Department of Medicine,Cook County Health & Hospitals System,Chicago,Illinois.
2Division of Infectious Diseases,Advocate Christ Medical Center,Oak Lawn,Illinois.
Infect Control Hosp Epidemiol. 2018 Jul;39(7):765-770. doi: 10.1017/ice.2018.76. Epub 2018 Apr 26.
OBJECTIVETo evaluate probiotics for the primary prevention of Clostridium difficile infection (CDI) among hospital inpatients.DESIGNA before-and-after quality improvement intervention comparing 12-month baseline and intervention periods.SETTINGA 694-bed teaching hospital.INTERVENTIONWe administered a multispecies probiotic comprising L. acidophilus (CL1285), L. casei (LBC80R), and L. rhamnosus (CLR2) to eligible antibiotic recipients within 12 hours of initial antibiotic receipt through 5 days after final dose. We excluded (1) all patients on neonatal, pediatric and oncology wards; (2) all individuals receiving perioperative prophylactic antibiotic recipients; (3) all those restricted from oral intake; and (4) those with pancreatitis, leukopenia, or posttransplant. We defined CDI by symptoms plus C. difficile toxin detection by polymerase chain reaction. Our primary outcome was hospital-onset CDI incidence on eligible hospital units, analyzed using segmented regression.RESULTSThe study included 251 CDI episodes among 360,016 patient days during the baseline and intervention periods, and the incidence rate was 7.0 per 10,000 patient days. The incidence rate was similar during baseline and intervention periods (6.9 vs 7.0 per 10,000 patient days; P=.95). However, compared to the first 6 months of the intervention, we detected a significant decrease in CDI during the final 6 months (incidence rate ratio, 0.6; 95% confidence interval, 0.4-0.9; P=.009). Testing intensity remained stable between the baseline and intervention periods: 19% versus 20% of stools tested were C. difficile positive by PCR, respectively. From medical record reviews, only 26% of eligible patients received a probiotic per the protocol.CONCLUSIONSDespite poor adherence to the protocol, there was a reduction in the incidence of CDI during the intervention, which was delayed ~6 months after introducing probiotic for primary prevention.Infect Control Hosp Epidemiol 2018;765-770.
评估益生菌对住院患者中艰难梭菌感染（CDI）的一级预防作用。
在 12 个月的基线期和干预期进行前后质量改进干预比较。
一家拥有 694 张床位的教学医院。
我们给符合条件的抗生素接受者在初始抗生素接受后 12 小时内至最后一剂后 5 天内给予包含嗜酸乳杆菌（CL1285）、干酪乳杆菌（LBC80R）和鼠李糖乳杆菌（CLR2）的多菌种益生菌。我们排除了（1）所有在新生儿、儿科和肿瘤科病房的患者；（2）所有接受围手术期预防用抗生素的患者；（3）所有限制口服摄入的患者；以及（4）患有胰腺炎、白细胞减少症或移植后的患者。我们通过聚合酶链反应检测粪便中艰难梭菌毒素来定义 CDI。我们的主要结局是在合格的住院病房中出现医院获得性 CDI 的发生率，使用分段回归进行分析。
在基线期和干预期，360016 个患者日中有 251 例 CDI 发作，发病率为每 10000 患者日 7.0 例。在基线期和干预期，发病率相似（每 10000 患者日 6.9 与 7.0 例；P=0.95）。然而，与干预的前 6 个月相比，我们发现最后 6 个月的 CDI 显著减少（发病率比，0.6；95%置信区间，0.4-0.9；P=0.009）。在基线期和干预期之间，检测强度保持稳定：通过 PCR 检测，分别有 19%和 20%的粪便呈艰难梭菌阳性。从病历回顾中，只有 26%的符合条件的患者按照方案接受了益生菌。
尽管对方案的依从性较差，但在引入益生菌进行一级预防后约 6 个月，CDI 的发病率有所下降。感染控制与医院流行病学 2018；765-770。
