Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis. 2021 Oct 20;73(8):1330-1337. doi: 10.1093/cid/ciab417.
Primary prevention of Clostridioides difficile infection (CDI) is a priority for hospitals. Probiotics have the potential to interfere with colonization and CDI. In this study, we evaluated the impact of a computerized clinical decision support (CCDS) tool to prescribe probiotics for primary prevention of CDI among adult hospitalized patients.
A CCDS tool was implemented into the electronic medical record at 4 hospitals to prompt prescription of a probiotic preparation at the time of antibiotic prescription in high-risk patients in May 2019. Interrupted time series using segmented regression analysis was conducted to evaluate hospital-wide CDI incidence for the year pre- and post-CCDS implementation. In addition, multivariable logistic regression was used to evaluate CDI incidence in patients who qualified for probiotics in the pre- vs post-intervention periods, adjusting for potential confounders. To adjust for potential differences in patients who received probiotics in the post-intervention period, propensity score-matched pairs were developed to evaluate CDI risk by receipt of probiotics.
Quarterly CDI incidence increased over time post-intervention relative to baseline trends (slope change, 1.4; 95% confidence interval [CI], .9-1.9). The odds ratio (OR) of CDI was 1.41 in eligible patients post-intervention compared with pre-intervention (adjusted OR, 1.41; 95% CI, 1.11-1.79). Propensity score-matched analysis showed that patients who received probiotics did not have lower rates of CDI compared with those who did not receive probiotics (OR, 1.46; 95% CI, .87-2.45).
Use of probiotics for primary prevention of CDI among adult inpatients receiving antibiotics is not supported.
艰难梭菌感染（CDI）的一级预防是医院的重点。益生菌具有干扰定植和 CDI 的潜力。在这项研究中，我们评估了计算机临床决策支持（CCDS）工具对成年住院患者中 CDI 一级预防抗生素处方中益生菌使用的影响。
2019 年 5 月，在 4 家医院的电子病历中实施了 CCDS 工具，以在高危患者抗生素处方时提示开具益生菌制剂。采用分段回归分析对 CCDS 实施前后的医院范围内 CDI 发生率进行中断时间序列分析。此外，多变量逻辑回归用于评估符合益生菌条件的患者在干预前后的 CDI 发生率，调整潜在混杂因素。为了调整干预后接受益生菌的患者潜在差异，采用倾向评分匹配对来评估益生菌的接受情况对 CDI 风险的影响。
与基线趋势相比，干预后每季度 CDI 发生率呈上升趋势（斜率变化，1.4；95%置信区间 [CI]，.9-1.9）。与干预前相比，合格患者的 CDI 比值比（OR）为 1.41（调整后 OR，1.41；95% CI，1.11-1.79）。倾向评分匹配分析显示，接受益生菌的患者与未接受益生菌的患者相比，CDI 发生率并没有降低（OR，1.46；95% CI，.87-2.45）。
在接受抗生素治疗的成年住院患者中，益生菌用于 CDI 的一级预防是不支持的。
