Wombwell E, et al. Clin Infect Dis 2020.
BACKGROUND: Hospital Onset Clostridioides difficile infection (HO-CDI) is a costly problem leading to readmissions, morbidity and mortality. We evaluated the effect of a single probiotic strain, Saccharomyces boulardii, at a standardized dose on the risk of HO-CDI within hospitalized patients administered antibiotics frequently associated with HO-CDI.
METHODS: This retrospective cohort study merged hospital prescribing data with HO-CDI case data. The study assessed patients hospitalized from January 2016 through March 2017 that were administered at least one dose of an antibiotic frequently associated with HO-CDI during hospitalization. Associations between S. boulardii administration, including timing, and HO-CDI incidence were evaluated by multivariable logistic regression.
RESULTS: The study included 8,763 patients. HO-CDI incidence was 0.66% in the overall cohort. HO-CDI incidence was 0.56% and 0.82% among patients co-administered S. boulardii with antibiotics and not co-administered S. boulardii, respectively. In adjusted analysis, patients co-administered S. boulardii had a reduced risk of HO-CDI (OR=0.57, 95% CI 0.33-0.96, p=0.04) compared to patients not co-administered S. boulardii. Patients co-administered S. boulardii within 24-hours of antibiotic start demonstrated a reduced risk of HO-CDI (OR=0.47, 95% CI 0.23-0.97, p=0.04) compared to those co-administered S. boulardii after 24-hours of antibiotic start.
CONCLUSIONS: S. boulardii administered to hospitalized patients prescribed antibiotics frequently linked with HO-CDI was associated with a reduced risk of HO-CDI.