Saccharomyces boulardii prophylaxis for targeted antibiotics and infectious indications to reduce healthcare facility-onset Clostridioides difficile infection |
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| Institution: | 1. Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, USA;2. Department of Pharmacy, Centerpoint Medical Center, Independence, Missouri, USA;1. Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou 510632, PR China;2. Infectious Diseases Institute, Guangzhou Eighth People''s Hospital, Guangdong, China;3. School of Pharmaceutical Sciences, Health Science Center, Shenzhen University, Shenzhen, China;1. Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, United States;2. Animal Resource Program, Atrium Health Wake Forest Baptist, Winston Salem, NC, United States;3. Department of Comparative Medicine, Worldwide Research, Development, and Medical, Pfizer, Cambridge, MA, United States;4. Novartis Institutes for BioMedical Research, Cambridge, MA, United States;5. Merck Research Laboratories, Merck, South San Francisco, CA, United States;6. Department of Medicine, Columbia University, New York, NY, United States;7. Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States;8. Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States;1. Department of Pharmacy, Guangdong Second Provincial General Hospital, No.466 Middle Xingang Road, Guangzhou, 510317, China;2. Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, No. 1838 Shatai South Road, Baiyun District, Guangzhou, 510515, China;3. Department of Pharmacy, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, No.23 Haipang Street, North Street, Jiangmen, 529030, China;1. Laboratório de Entomologia I, Fiocruz Rondônia – Fundação Oswaldo Cruz, Lagoa, 76812-245, Porto Velho, Rondônia State, Brazil;2. Programa de Pós-Graduação em Biologia Experimental – PGBIOEXP, Fundação Universidade Federal de Rondônia – UNIR, BR-364, km 9.5, 76801-059, Porto Velho, Rondônia State, Brazil;3. Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Instituto Leônidas e Maria Deane – Fiocruz Amazônia, Adrianópolis, 69057-070, Manaus, Amazonas State, Brazil;4. Programa de Pós-Graduação em Biologia Celular e Molecular, Instituto Oswaldo Cruz, Fiocruz, Manguinhos, 21040-360, Rio de Janeiro State, Brazil;5. Programa de Pós-Graduação em Biologia da Interação Patógeno-Hospedeiro, Instituto Leônidas e Maria Deane – Fiocruz Amazônia, Adrianópolis, 69057-070, Manaus, Amazonas State, Brazil;6. Laboratório de Virologia Molecular, Fiocruz Rondônia – Fundação Oswaldo Cruz, Lagoa, 76812-245, Porto Velho, Rondônia State, Brazil;7. Instituto Nacional de Epidemiologia da Amazônia Ocidental – INCT-EpiAmO, Lagoa, 76812-245, Porto Velho, Rondônia State, Brazil;1. Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu, China;2. Institute of Oceanology and Marine Fisheries, Nantong, 226007, Jiangsu, China;3. Guangxi Key Laboratory for Polysaccharide Materials and Modifications, School of Marine Sciences and Biotechnology, Guangxi University for Nationalities, Nanning, 530008, Guangxi, China;1. Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 255, CEP: 01246-903, São Paulo, Brazil;2. Laboratório de Investigação Médica, Bacteriologia e Resistência Antimicrobiana, Instituto de Medicina Tropical da FMUSP (LIM 49), Av. Dr. Enéas Carvalho de Aguiar, 470, CEP: 05403-000, São Paulo, Brazil;3. Universidade Federal de Santa Catarina, Florianópolis, Brazil;4. Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373, CCS, Bloco I, Laboratório I2-59, Cidade Universitária, CEP: 21941-902, Rio de Janeiro, Brazil;5. Sessão de Microbiologia, Divisão de Laboratório de Laboratório Central, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Enéas de Carvalho Aguiar, 155, CEP: 05403-010, São Paulo, Brazil;6. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom |
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| Abstract: | BackgroundProbiotic prophylaxis for Clostridioides difficile infection (CDI) is controversial stemming from deficits in strain and disease specificity considerations and concern for adverse effects. Here risk for healthcare facility-onset CDI (HO-CDI) dependent on concomitant antibiotic and infectious indication is assessed to identify opportunities for targeted prophylaxis.MethodsRetrospective matched-cohort study from January 2016 through March 2019. Patient-admissions administered high risk antibiotics were categorized by Saccharomyces boulardii administration and matched 1:1 to non-recipients. Unadjusted and adjusted HO-CDI risk estimated using Cox proportional hazards regression.ResultsS. boulardii administration was associated with 48% risk reduction for HO-CDI compared to non-recipients (aHR 0.52, 95% CI: 0.31–0.87). Patient-admissions administered antibiotics and S. boulardii for a pneumonia indication exhibited a 57% reduction in risk for HO-CDI (aHR 0.43, 95% CI: 0.19–0.95). Administration of S. boulardii with ceftriaxone was associated with a 76% reduced risk of HO-CDI (aHR 0.24, 95% CI: 0.11–0.53) compared to ceftriaxone without S. boulardii, number needed to treat of 100.ConclusionsS. boulardii administration is associated with a significant HO-CDI risk reduction for inpatients receiving antibiotics associated with CDI. Institutions interested in targeted use of S. boulardii to limit potential adverse effects may consider prophylaxis for inpatients with pneumonia or receiving ceftriaxone. |
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| Keywords: | Clostridioides infections Saccharomyces Probiotics Nosocomial infection Prevention and control |
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