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Betz M, Uzueta A, Rasmussen H, Gregoire M, Vanderwall C, Witowich G. Knowledge, use and perceptions of probiotics and prebiotics in hospitalised patients. Nutr Diet 2015. [DOI: 10.1111/1747-0080.12177] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Melanie Betz
- Food and Nutrition; Rush University Medical Center; Chicago Illinois USA
| | - Anne Uzueta
- Clinical Nutrition; Advocate Christ Hospital; Chicago Illinois USA
| | - Heather Rasmussen
- Food and Nutrition; Rush University Medical Center; Chicago Illinois USA
| | - Mary Gregoire
- Food and Nutrition; Rush University Medical Center; Chicago Illinois USA
| | | | - Gretchen Witowich
- Food and Nutrition; Rush University Medical Center; Chicago Illinois USA
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202
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Xie C, Li J, Wang K, Li Q, Chen D. Probiotics for the prevention of antibiotic-associated diarrhoea in older patients: a systematic review. Travel Med Infect Dis 2015; 13:128-34. [PMID: 25805164 DOI: 10.1016/j.tmaid.2015.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Here, we evaluated the efficacy of probiotic interventions in prevention of antibiotic-associated diarrhoea (AAD) and Clostridium difficile diarrhoea (CDD) in older patients. METHODS PubMed, Embase, CENTRAL, CINAHL, and Web of Science were comprehensively searched from their dates of inception to May 2014. Only randomised controlled trials reporting data on probiotics including Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and Bacillus-alone or in combination-versus placebo or absence of treatment in older patients (age ≥65 years) were included. Risk ratios (RRs) for AAD and CDD relative to placebo or absence of treatment were estimated. RESULTS Six trials with a total of 3562 patients were included. Only one trial showed that Bacillus licheniformis was effective for preventing AAD in older patients. However, there was no preventive effect for AAD and CDD with Lactobacillus acidophilus (Florajen), Lactobacillus casei Shirota, Saccharomyces cerevisiae (boulardii) lyo, mixture of Lactobacillus acidophilus and Bifidobacterium bifidum (Cultech strains), and mixture of Lactobacillus acidophilus CUL60, CUL21, Bifidobacterium bifidum CUL20 and B. lactis CUL34. CONCLUSIONS Our findings indicate that probiotics may not reduce the risk of AAD and CDD in older patients. However, with current published data, it is difficult to draw concrete conclusions. To confirm these findings, sample sizes, multi-centre, double-blind studies that consider factors such as probiotic strains and types of antibiotics are required.
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Affiliation(s)
- Chunhong Xie
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiajing Li
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kejia Wang
- Department of Gastroenterology, Banan People's Hospital of Chongqing, Chongqing, China
| | - Qinqin Li
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daorong Chen
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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203
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Colonization with toxinogenic C. difficile upon hospital admission, and risk of infection: a systematic review and meta-analysis. Am J Gastroenterol 2015; 110:381-90; quiz 391. [PMID: 25732416 DOI: 10.1038/ajg.2015.22] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/07/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It has been suggested that colonization with C. difficile protects from infection. Nevertheless, the association between carriage of toxinogenic strains and ensuing C. difficile infections (CDIs) has not been studied. METHODS We searched PubMed and EMBASE databases up to 20 June 2014, using the term "difficile". Our primary outcomes of interest included the prevalence of isolation of toxinogenic C. difficile or its toxins from asymptomatic patients on hospital admission through stool or rectal swab testing and the risk of ensuing infection among colonized and noncolonized patients. Data on previous hospitalization, antibiotic, and proton pump inhibitor (PPI) use and prior CDIs among colonized and noncolonized patients were also extracted. RESULTS Nineteen out of 26,081 studies on 8,725 patients were included. The pooled prevalence of toxinogenic C. difficile colonization was 8.1% (95% confidence interval (CI) 5.7-11.1%), with an increasing trend over time (P=0.003), and 10.0% (95% CI 7.1-13.4%) among North American studies. Patients colonized upon hospital admission had a 5.9 times higher risk of subsequent CDIs compared with noncolonized patients (relative risk (RR) 5.86; 95% CI 4.21-8.16). The risk of CDI for colonized patients was 21.8% (95% CI 7.9-40.1%), which was significantly higher than that of noncolonized patients (3.4%; 95% CI 1.5-6.0%; P=0.03), with an attributable risk of 18.4%. History of hospitalization during the previous 3 months was associated with a higher risk of colonization (RR 1.63; 95% CI 1.13-2.34), as opposed to previous antibiotic (RR 1.07; 95% CI 0.75-1.53) and PPI use (RR 1.44; 95% CI 0.94-2.23), as well as history of CDI (RR 1.45; 95% CI 0.66-3.18) that had no impact. CONCLUSIONS Over 8% of admitted patients are carriers of toxinogenic C. difficile with an almost 6 times higher risk of infection. These findings update current knowledge regarding the contribution of colonization in CDI epidemiology and stress the importance of preventive measures toward colonized patients.
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Abstract
OPINION STATEMENT Clostridium difficile infection (CDI) is the leading cause of death due to gastrointestinal infections in the US and is the most common cause of nosocomial diarrhea. The emergence of a hypervirulent strain in the early 2000s has been associated with a dramatic increase in the number and severity of cases in the US, Canada, and several other countries. Most cases are related to antibiotic use, but sporadic cases occur in otherwise healthy individuals with no risk factors. Morbidity and mortality are highest in the elderly. Diagnosis is confirmed by detection of C. difficile toxin in the stools. Treatment should be stratified by severity of disease, with metronidazole use for mild disease cases and vancomycin for severe disease. Recurrent CDI occurs in 10-20 % of cases. A first recurrence can be treated with a ten-day regimen of metronidazole or vancomycin; a second recurrence is best treated by a pulsed regimen of vancomycin. In patients with multiple (three or more) recurrences, fecal microbiota transplant has a high rate of success. The most important methods of prevention are wise antibiotic policies, hand hygiene, isolation, and barrier methods in hospital and long-term care facilities (LCTF) settings.
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205
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Barral M, Boudiaf M, Dohan A, Hoeffel C, Camus M, Pautrat K, Fishman E, Cohen S, Soyer P. MDCT of acute colitis in adults: An update in current imaging features. Diagn Interv Imaging 2015; 96:133-49. [DOI: 10.1016/j.diii.2014.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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206
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Affiliation(s)
- J.J. Keller
- Medisch Centrum Haaglanden, The Hague, The Netherlands;
| | - E.J. Kuijper
- Department of Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
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207
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Dubberke ER, Carling P, Carrico R, Donskey CJ, Loo VG, McDonald LC, Maragakis LL, Sandora TJ, Weber DJ, Yokoe DS, Gerding DN. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 Update. Infect Control Hosp Epidemiol 2015; 35:628-45. [PMID: 24799639 DOI: 10.1086/676023] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Erik R Dubberke
- Washington University School of Medicine, St. Louis, Missouri
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208
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Dubberke ER, Carling P, Carrico R, Donskey CJ, Loo VG, McDonald LC, Maragakis LL, Sandora TJ, Weber DJ, Yokoe DS, Gerding DN. Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2015. [DOI: 10.1086/522262] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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209
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Ondansetron and probiotics in the management of pediatric acute gastroenteritis in developed countries. Curr Opin Gastroenterol 2015; 31:1-6. [PMID: 25333367 DOI: 10.1097/mog.0000000000000132] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Acute gastroenteritis (AGE) is a common and impactful disease, typically managed with supportive care. There is considerable interest in the role of adjunctive therapies, particularly ondansetron and probiotics in improving AGE outcomes. The purpose of this review is to present the latest evidence regarding the use of these agents in children with AGE in developed countries. RECENT FINDINGS Single-dose oral ondansetron is effective and safe in reducing hospital admissions and the use of intravenous rehydration in children with AGE in emergency-department-based trials. Ondansetron use has increased significantly; however, 'real-world' studies of effectiveness have documented less impressive clinical impacts. Similarly, probiotic consumption is growing rapidly. Although several strains appear to reduce the duration of diarrhea in hospitalized children, current data are insufficient to support the routine use of probiotics in outpatient pediatric AGE. SUMMARY Ondansetron and probiotics may improve patient outcomes in pediatric AGE. Appropriate strategies are needed to optimally integrate oral ondansetron into clinical practice to maximize its potential benefits. Although probiotics remain a promising option, there are challenges in generalizing the data available to patients presenting for outpatient care. Large randomized controlled trials are needed to definitively guide the clinical use of probiotics in outpatients in developed countries.
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210
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Fisher A, Varendran R. Letter: clinical predictors of Clostridium difficile infection - advanced age and residential status are important factors for prediction and prevention. Aliment Pharmacol Ther 2015; 41:232-3. [PMID: 25511770 DOI: 10.1111/apt.13014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 10/12/2014] [Indexed: 02/07/2023]
Affiliation(s)
- A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia.
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211
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Issa I, Moucari R. Probiotics for antibiotic-associated diarrhea: Do we have a verdict? World J Gastroenterol 2014; 20:17788-17795. [PMID: 25548477 PMCID: PMC4273129 DOI: 10.3748/wjg.v20.i47.17788] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/12/2014] [Accepted: 07/25/2014] [Indexed: 02/07/2023] Open
Abstract
Probiotics use has increased tremendously over the past ten years. This was coupled with a surge of data relating their importance in clinical practice. Antibiotic-associated diarrhea, whose frequency has risen recently, was one of the earliest targets with data published more than ten years ago. Unfortunately, available trials suffer from severe discrepancies associated with variability and heterogeneity of several factors. Most published randomized controlled trials and subsequent meta-analyses suggest benefit for probiotics in the prevention of antibiotic-associated diarrhea. The same seems to also apply when the data is examined for Clostridium difficile-associated colitis. However, the largest randomized double-blind placebo-controlled trial to date examining the use of a certain preparation of probiotics in antibiotic-associated diarrhea showed disappointing results, but it was flawed with several drawbacks. The commonest species of probiotics studied across most trials is Lactobacillus; however, other types have also shown similar benefit. Probiotics have enjoyed an impeccable safety reputation. Despite a few reports of severe infections sometimes leading to septicemia, most of the available trials confirm their harmless behavior and show similar adverse events compared to placebo. Since a consensus dictating its use is still lacking, it would be advisable at this point to suggest prophylactic use of probiotics to certain patients at risk for antibiotic-associated diarrhea or to those who suffered previous episodes.
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212
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Rodriguez S, Hernandez MB, Tarchini G, Zaleski M, Vatanchi M, Cardona L, Castro-Pavia F, Schneider A. Risk of Clostridium difficile infection in hospitalized patients receiving metronidazole for a non-C difficile infection. Clin Gastroenterol Hepatol 2014; 12:1856-61. [PMID: 24681079 DOI: 10.1016/j.cgh.2014.02.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/20/2014] [Accepted: 02/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Antibiotics often are given to prevent infections but also constitute a risk factor for Clostridium difficile infection (CDI). Metronidazole is an effective treatment for CDI. We investigated whether prophylactic administration of metronidazole to patients before they receive other antibiotics reduces the risk of CDI. METHODS We performed a retrospective cohort analysis of data collected from 12,026 high-risk patients admitted to Cleveland Clinic Foundation Hospitals from 2008 through 2012. High-risk patients were defined as age 55 or older who received a broad-spectrum antibiotic (piperacillin-tazobactam or ciprofloxacin) and a gastric acid suppressant (a proton pump inhibitor or a histamine-2 receptor blocker) during their hospitalization. Development of CDI was compared between patients who received metronidazole for non-CDI indications before broad-spectrum antibiotics (n = 811) and those who did not (n = 11,215). Logistic regression was used to control for patient demographics and comorbidities. RESULTS The rate of CDI was 1.4% (n = 11) among the patients who received metronidazole for non-CDI indications and 6.5% (n = 728) among those who did not. This was observed to be an 80% reduction in CDI among patients who received metronidazole (odds ratio, 0.21; 95% confidence interval, 0.11-0.38; P < .001), adjusted for age, sex, and comorbidities. CONCLUSIONS Based on a retrospective analysis, metronidazole might be used to prevent CDI in certain high-risk patients. Prospective controlled trials are necessary before making further recommendations.
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Affiliation(s)
- Sandra Rodriguez
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida.
| | - Marlow B Hernandez
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Giorgio Tarchini
- Department of Infectious Disease, Cleveland Clinic Florida, Weston, Florida
| | - Megan Zaleski
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Marjon Vatanchi
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Lyssette Cardona
- Department of Infectious Disease, Cleveland Clinic Florida, Weston, Florida
| | - Fernando Castro-Pavia
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida
| | - Alison Schneider
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida
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213
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The overarching influence of the gut microbiome on end-organ function: the role of live probiotic cultures. Pharmaceuticals (Basel) 2014; 7:954-89. [PMID: 25244509 PMCID: PMC4190499 DOI: 10.3390/ph7090954] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/09/2014] [Accepted: 09/10/2014] [Indexed: 12/13/2022] Open
Abstract
At the time of birth, humans experience an induced pro-inflammatory beneficial event. The mediators of this encouraged activity, is a fleet of bacteria that assault all mucosal surfaces as well as the skin. Thus initiating effects that eventually provide the infant with immune tissue maturation. These effects occur beneath an emergent immune system surveillance and antigenic tolerance capability radar. Over time, continuous and regulated interactions with environmental as well as commensal microbial, viral, and other antigens lead to an adapted and maintained symbiotic state of tolerance, especially in the gastrointestinal tract (GIT) the organ site of the largest microbial biomass. However, the perplexing and much debated surprise has been that all microbes need not be targeted for destruction. The advent of sophisticated genomic techniques has led to microbiome studies that have begun to clarify the critical and important biochemical activities that commensal bacteria provide to ensure continued GIT homeostasis. Until recently, the GIT and its associated micro-biometabolome was a neglected factor in chronic disease development and end organ function. A systematic underestimation has been to undervalue the contribution of a persistent GIT dysbiotic (a gut barrier associated abnormality) state. Dysbiosis provides a plausible clue as to the origin of systemic metabolic disorders encountered in clinical practice that may explain the epidemic of chronic diseases. Here we further build a hypothesis that posits the role that subtle adverse responses by the GIT microbiome may have in chronic diseases. Environmentally/nutritionally/and gut derived triggers can maintain microbiome perturbations that drive an abnormal overload of dysbiosis. Live probiotic cultures with specific metabolic properties may assist the GIT microbiota and reduce the local metabolic dysfunctions. As such the effect may translate to a useful clinical treatment approach for patients diagnosed with a metabolic disease for end organs such as the kidney and liver. A profile emerges that shows that bacteria are diverse, abundant, and ubiquitous and have significantly influenced the evolution of the eukaryotic cell.
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214
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The human microbiome. Early life determinant of health outcomes. Ann Am Thorac Soc 2014; 11 Suppl 1:S7-12. [PMID: 24437411 DOI: 10.1513/annalsats.201306-186mg] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The development of new technologies to isolate and identify microbial genomes has markedly increased our understanding of the role of microbiomes in health and disease. The idea, first proposed as part of the hygiene hypothesis, that environmental microbes influence the developmental trajectories of the immune system in early life, has now been considerably extended and refined. The abundant microbiota present in mucosal surfaces, especially the gut, is actively selected by the host through complex receptor systems that respond differentially depending on the molecular patterns presented to mucosal cells. Germ-free mice are more likely to develop allergic airway inflammation and show alterations in normal motor control and anxiety. These effects can be reversed by neonatal microbial recolonization but remain unchanged if recolonization occurs in adults. What emerges from these recent studies is the discovery of a complex, major early environmental determinant of lifetime human phenotypes. To change the natural course of asthma, obesity, and other chronic inflammatory conditions, active manipulation of the extensive bacterial, phage, and fungal metagenomes present in mucosal surfaces may be required, specifically during the developing years. Domesticating the human microbiome and adapting it to our health needs may be a challenge akin to, but far more complex than, the one faced by humanity when a few dozen species of plants and animals were domesticated during the transition between hunter-gatherer and sedentary societies after the end of the Pleistocene era.
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215
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Ray D, Alpini G, Glaser S. Probiotic Bifidobacterium species: potential beneficial effects in diarrheal disorders. Focus on "Probiotic Bifidobacterium species stimulate human SLC26A3 gene function and expression in intestinal epithelial cells". Am J Physiol Cell Physiol 2014; 307:C1081-3. [PMID: 25209264 DOI: 10.1152/ajpcell.00300.2014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Debolina Ray
- Division of Gastroenterology, Department of Medicine, Texas A & M University Health Science Center, Temple, Texas
| | - Gianfranco Alpini
- Research, Central Texas Veterans Health Care System, Temple, Texas; Scott & White Digestive Disease Research Center, Scott & White Healthcare, Temple, Texas; and Division of Gastroenterology, Department of Medicine, Texas A & M University Health Science Center, Temple, Texas
| | - Shannon Glaser
- Research, Central Texas Veterans Health Care System, Temple, Texas; Scott & White Digestive Disease Research Center, Scott & White Healthcare, Temple, Texas; and Division of Gastroenterology, Department of Medicine, Texas A & M University Health Science Center, Temple, Texas
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216
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Gupta SB, Dubberke ER. Overview and changing epidemiology of Clostridium difficile infection. SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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217
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Kumar A, Hecht C, Priyamvada S, Anbazhagan AN, Alakkam A, Borthakur A, Alrefai WA, Gill RK, Dudeja PK. Probiotic Bifidobacterium species stimulate human SLC26A3 gene function and expression in intestinal epithelial cells. Am J Physiol Cell Physiol 2014; 307:C1084-92. [PMID: 25143346 DOI: 10.1152/ajpcell.00194.2014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
SLC26A3, or downregulated in adenoma (DRA), plays a major role in mediating Cl(-) absorption in the mammalian intestine. Disturbances in DRA function and expression have been implicated in intestinal disorders such as congenital Cl(-) diarrhea and gut inflammation. We previously showed that an increase in DRA function and expression by Lactobacillus acidophilus and its culture supernatant (CS) might underlie antidiarrheal effects of this probiotic strain. However, the effects of Bifidobacterium species, important inhabitants of the human colon, on intestinal Cl(-)/HCO3 (-) exchange activity are not known. Our current results demonstrate that CS derived from Bifidobacterium breve, Bifidobacterium infantis, and Bifidobacterium bifidum increased anion exchange activity in Caco-2 cells (∼1.8- to 2.4-fold). Consistent with the increase in DRA function, CS also increased the protein, as well as the mRNA, level of DRA (but not putative anion transporter 1). CS of all three Bifidobacterium sp. increased DRA promoter activity (-1,183/+114 bp) in Caco-2 cells (1.5- to 1.8-fold). Furthermore, the increase in DRA mRNA expression by CS of B. breve and B. infantis was blocked in the presence of the transcription inhibitor actinomycin D (5 μM) and the ERK1/2 MAPK pathway inhibitor U0126 (10 μM). Administration of live B. breve, B. infantis, and B. bifidum by oral gavage to mice for 24 h increased DRA mRNA and protein levels in the colon. These data demonstrate an upregulation of DRA via activation of the ERK1/2 pathway that may underlie potential antidiarrheal effects of Bifidobacterium sp.
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Affiliation(s)
- Anoop Kumar
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Singhania University Pacheri Bari, Rajasthan, India
| | - Cameron Hecht
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Shubha Priyamvada
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Arivarasu N Anbazhagan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Anas Alakkam
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Alip Borthakur
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Waddah A Alrefai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and
| | - Ravinder K Gill
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Pradeep K Dudeja
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and
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218
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Vassallo A, Tran MCN, Goldstein EJC. Clostridium difficile: improving the prevention paradigm in healthcare settings. Expert Rev Anti Infect Ther 2014; 12:1087-102. [DOI: 10.1586/14787210.2014.942284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Angela Vassallo
- Department of Infection Prevention, Providence Saint John’s Health Center,
2121 Santa Monica Blvd, Santa Monica, CA 90404, USA
| | - Mai-Chi N Tran
- Department of Pharmacy, Providence Saint John’s Health Center,
2121 Santa Monica Blvd, Santa Monica, CA 90404, USA
| | - Ellie JC Goldstein
- Department of Infectious Diseases, Providence Saint John’s Health Center,
2121 Santa Monica Blvd, Santa Monica, CA 90404, USA
- The UCLA School of Medicine,
Los Angeles, CA 90073, USA
- The R M Alden Research Laboratory,
Santa Monica CA, 90404, USA
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219
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Funding may influence trial results examining probiotics and Clostridium difficile diarrhea rates. Am J Gastroenterol 2014; 109:1081-2. [PMID: 24989097 DOI: 10.1038/ajg.2014.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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220
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Affiliation(s)
- Agostino Colli
- Department of Medicine, A. Manzoni Hospital, Lecco, Italy
| | - Pietro Pozzoni
- Department of Medicine, A. Manzoni Hospital, Lecco, Italy
| | - Dario Conte
- Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Department of Clinical Sciences, L. Sacco Hospital, Milan, Italy
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221
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Pareja-Sierra T. [Diarrhea associated with Clostridium difficile in the elderly: new perspectives]. Rev Esp Geriatr Gerontol 2014; 49:188-193. [PMID: 24685366 DOI: 10.1016/j.regg.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/15/2014] [Indexed: 06/03/2023]
Abstract
Infection due to Clostridium difficile is currently the main cause of hospital acquired gastrointestinal disease. Its prevalence in the elderly population is higher due to there being many associated risk factors in this age group, such as comorbidity, frequent exposure to the healthcare or residential home setting, immunosenescence, greater consumption of antibiotics, and antiacids. The diagnostic techniques have notably improved in the last few years, which could also account for an increase in its diagnosis. The new expert consensus recommendations propose stratifying the clinical situation of the patient in order to choose the treatment option. Therapeutic options have recently been included in the new Clinical Guidelines, such as flidaxomicin or fecal transplants, with encouraging results, particularly for the control of frequent recurrences.
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Affiliation(s)
- Teresa Pareja-Sierra
- Sección de Geriatría, Hospital Universitario de Guadalajara, Sescam, Guadalajara, España.
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222
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Tanabe S, Suzuki T, Wasano Y, Nakajima F, Kawasaki H, Tsuda T, Nagamine N, Tsurumachi T, Sugaya K, Akita H, Takagi M, Takagi K, Inoue Y, Asai Y, Morita H. Anti-inflammatory and Intestinal Barrier-protective Activities of Commensal Lactobacilli and Bifidobacteria in Thoroughbreds: Role of Probiotics in Diarrhea Prevention in Neonatal Thoroughbreds. J Equine Sci 2014; 25:37-43. [PMID: 25013357 PMCID: PMC4090357 DOI: 10.1294/jes.25.37] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/11/2014] [Indexed: 12/25/2022] Open
Abstract
We previously isolated the commensal bacteria lactobacilli and bifidobacteria from the Thoroughbred intestine and prepared the horse probiotics LacFi(TM), consisting of Lactobacillus ruminis KK14, L. equi KK 15, L. reuteri KK18, L. johnsonii KK21, and Bifidobacterium boum HU. Here, we found that the five LacFi(TM) constituent strains remarkably suppressed pro-inflammatory interleukin-17 production in mouse splenocytes stimulated with interleukin-6 and transforming growth factor-β. The protective effects of the probiotic on impaired intestinal barrier function were evaluated in Caco-2 cells treated with tumor necrosis factor-α. Evaluation of transepithelial resistance showed that all the strains exhibited intestinal barrier protective activity, with significant suppression of barrier impairment by L. reuteri KK18. The LacFi(TM) constituent strains were detected in neonatal LacFi(TM)-administered Thoroughbred feces using polymerase chain reaction denaturing gradient gel electrophoresis and culture methods. These five strains were found to be the predominant lactobacilli and bifidobacteria in the intestinal microbiota of LacFi(TM)-administered Thoroughbreds. Administration of LacFi(TM) to neonatal Thoroughbreds decreased diarrhea incidence from 75.9% in the control group (n=29 neonatal Thoroughbreds) to 30.7% in the LacFi(TM)-administered group (n=101 neonatal Thoroughbreds) immediately after birth to 20 weeks after birth. LacFi(TM) treatment also prevented diarrhea especially at and around 4 weeks and from 10 to 16 weeks. The duration of diarrhea was also shorter in the probiotics-administered group (7.4 ± 0.8 days) than in the control group (14.0 ± 3.2 days). These results indicate that the LacFi(TM) probiotics regulates intestinal function and contributes to diarrhea prevention.
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Affiliation(s)
- Soichi Tanabe
- Graduate School of Biosphere Science, Hiroshima University, Higashi-hiroshima 739-8528, Japan
| | - Takuya Suzuki
- Graduate School of Biosphere Science, Hiroshima University, Higashi-hiroshima 739-8528, Japan
| | - Yuichiro Wasano
- Graduate School of Biosphere Science, Hiroshima University, Higashi-hiroshima 739-8528, Japan
| | | | | | | | | | | | | | | | | | - Kunihiko Takagi
- School of Life and Environmental Science, Azabu University, Kanagawa 252-5201, Japan
| | - Yoshinobu Inoue
- Hidaka Training and Research Center, Japan Racing Association, Hokkaido 057-0171, Japan
| | - Yo Asai
- Hidaka Training and Research Center, Japan Racing Association, Hokkaido 057-0171, Japan
| | - Hidetoshi Morita
- School of Veterinary Medicine, Azabu University, Kanagawa 252-5201, Japan
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223
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Huang W. Critical care medicine 2013: a review and prospect. J Thorac Dis 2014; 5:815-23. [PMID: 24409360 DOI: 10.3978/j.issn.2072-1439.2013.12.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 12/17/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Wei Huang
- Department of Critical Care Medicine, the First Hospital of Dalian Medical University, Dalian 116012, China
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224
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Kemgang TS, Kapila S, Shanmugam VP, Kapila R. Cross-talk between probiotic lactobacilli and host immune system. J Appl Microbiol 2014; 117:303-19. [PMID: 24738909 DOI: 10.1111/jam.12521] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/02/2014] [Accepted: 04/08/2014] [Indexed: 12/14/2022]
Abstract
The mechanism by which probiotic lactobacilli affect the immune system is strain specific. As the immune system is a multicompartmental system, each strain has its way to interact with it and induce a visible and quantifiable effect. This review summarizes the interplay existing between the host immune system and probiotic lactobacilli, that is, with emphasis on lactobacilli as a prototype probiotic genus. Several aspects including the bacterial-host cross-talk with the mucosal and systemic immune system are presented, as well as short sections on the competing effect towards pathogenic bacteria and their uses as delivery vehicle for antigens.
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Affiliation(s)
- T S Kemgang
- Department of Animal Biochemistry, National Dairy Research Institute, Karnal, Haryana, India; Department of Food Science/Nutrition, National School of AgroIndustrial Sciences, University of Ngaoundere, Ngaoundere, Adamaoua, Cameroon
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225
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Varughese CA, Vakil NH, Phillips KM. Antibiotic-associated diarrhea: a refresher on causes and possible prevention with probiotics--continuing education article. J Pharm Pract 2014; 26:476-82. [PMID: 24064436 DOI: 10.1177/0897190013499523] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Antibiotic-associated diarrhea (AAD) describes any unexplained diarrhea associated with the use of an antibiotic. AAD also includes infection caused by Clostridium difficile, however this organism only accounts for a small percentage of diarrhea caused by antibiotics. AAD can be caused by multiple other organisms including C perfringens, S aureus, and Candida. Some antibiotics are more likely to cause non-C difficile AAD, such as erythromycin and the penicillin class. AAD develops through the loss of normal flora and reduced colonic bacterial carbohydrate metabolism during antibiotic administration. There is an increasing interest in the use of probiotics for the prevention of AAD. There are several meta-analyses that report a relative risk reduction of AAD with the use of probiotics during antibiotic administration. Interpretation of these studies has been challenging due to the heterogeneity and size of the patient populations, unclear probiotic regimen, and unclear safety profile. Since AAD can be a reason for a patient to become non-compliant or receive incomplete treatment, clinicians should monitor for this potential adverse effect caused by antibiotics.
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226
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Scientific surgery. Br J Surg 2014. [DOI: 10.1002/bjs.9532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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227
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228
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Wachholz PA, Boas PJFV, dos Santos Nunes V, de Oliveira Vidal EI. Evidence on the role of prebiotics, probiotics, and synbiotics in gut health and disease prevention in the elderly. JOURNAL OF CLINICAL GERONTOLOGY AND GERIATRICS 2014; 5:1-2. [DOI: 10.1016/j.jcgg.2014.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
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229
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Khanna S, Pardi DS. Clostridium difficile infection: management strategies for a difficult disease. Therap Adv Gastroenterol 2014; 7:72-86. [PMID: 24587820 PMCID: PMC3903088 DOI: 10.1177/1756283x13508519] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Clostridium difficile was first described as a cause of diarrhea in 1978 and in the last three decades has reached an epidemic state with increasing incidence and severity in both healthcare and community settings. There also has been a rise in severe outcomes from C. difficile infection (CDI). There have been tremendous advancements in the field of CDI with the identification of newer risk factors, recognition of CDI in populations previously thought not at risk and development of better diagnostic modalities. Several treatment options are available for CDI apart from metronidazole and vancomycin, and include new drugs such as fidaxomicin and other options such as fecal microbiota transplantation. This review discusses the epidemiology, risk factors and outcomes from CDI, and focuses primarily on existing and evolving treatment modalities.
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Affiliation(s)
- Sahil Khanna
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Darrell S. Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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230
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Lenoir-Wijnkoop I, Nuijten MJC, Craig J, Butler CC. Nutrition economic evaluation of a probiotic in the prevention of antibiotic-associated diarrhea. Front Pharmacol 2014; 5:13. [PMID: 24596556 PMCID: PMC3926519 DOI: 10.3389/fphar.2014.00013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/23/2014] [Indexed: 12/26/2022] Open
Abstract
Introduction: Antibiotic-associated diarrhea (AAD) is common and frequently more severe in hospitalized elderly adults. It can lead to increased use of healthcare resources. We estimated the cost-effectiveness of a fermented milk (FM) with probiotic in preventing AAD and in particular Clostridium difficile-associated diarrhea (CDAD). Methods: Clinical effectiveness data and cost information were incorporated in a model to estimate the cost impact of administering a FM containing the probiotic Lactobacillus paracasei ssp paracasei CNCM I-1518 in a hospital setting. Preventing AAD by the consumption of the probiotic was compared to no preventive strategy. Results: The probiotic intervention to prevent AAD generated estimated mean cost savings of £339 per hospitalized patient over the age of 65 years and treated with antibiotics, compared to no preventive probiotic. Estimated cost savings were sensitive to variation in the incidence of AAD, and to the proportion of patients who develop non-severe/severe AAD. However, probiotics remained cost saving in all sensitivity analyses. Conclusion: Use of the fermented dairy drink containing the probiotic L. paracasei CNCM I-1518 to prevent AAD in older hospitalized patients treated with antibiotics could lead to substantial cost savings.
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Affiliation(s)
- Irene Lenoir-Wijnkoop
- Department of Pharmaceutical Sciences, University of Utrecht Utrecht, Netherlands ; Scientific Affairs, Danone Research Palaiseau, France
| | | | - Joyce Craig
- York Health Economics Consortium Limited, University of York York, UK
| | - Christopher C Butler
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University Cardiff, UK
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231
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IV ECO, III ECO, Johnson DA. Clinical update for the diagnosis and treatment of Clostridium difficile infection. World J Gastrointest Pharmacol Ther 2014; 5:1-26. [PMID: 24729930 PMCID: PMC3951810 DOI: 10.4292/wjgpt.v5.i1.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/06/2013] [Accepted: 12/09/2013] [Indexed: 02/06/2023] Open
Abstract
Clostridium difficile infection (CDI) presents a rapidly evolving challenge in the battle against hospital-acquired infections. Recent advances in CDI diagnosis and management include rapid changes in diagnostic approach with the introduction of newer tests, such as detection of glutamate dehydrogenase in stool and polymerase chain reaction to detect the gene for toxin production, which will soon revolutionize the diagnostic approach to CDI. New medications and multiple medical society guidelines have introduced changing concepts in the definitions of severity of CDI and the choice of therapeutic agents, while rapid expansion of data on the efficacy of fecal microbiota transplantation heralds a revolutionary change in the management of patients suffering multiple relapses of CDI. Through a comprehensive review of current medical literature, this article aims to offer an intensive review of the current state of CDI diagnosis, discuss the strengths and limitations of available laboratory tests, compare both current and future treatments options and offer recommendations for best practice strategies.
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232
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Affiliation(s)
- Andre C Kalil
- University of Nebraska Medical Center, Omaha, NE 68198, USA.
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233
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Affiliation(s)
- Mikhail Kogan
- George Washington University, Washington, DC 20037, USA.
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234
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Allen SJ, Gravenor MB, Wareham K, Wang D. Probiotics and antibiotic-associated diarrhoea - Authors' reply. Lancet 2014; 383:30. [PMID: 24388311 DOI: 10.1016/s0140-6736(13)62735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen J Allen
- College of Medicine, Swansea University, Swansea SA2 8PP, UK.
| | | | | | - Duolao Wang
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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235
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Urben LM, Wiedmar J, Boettcher E, Cavallazzi R, Martindale RG, McClave SA. Bugs or drugs: are probiotics safe for use in the critically ill? Curr Gastroenterol Rep 2014; 16:388. [PMID: 24986534 DOI: 10.1007/s11894-014-0388-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Probiotics are living microorganisms which have demonstrated many benefits in prevention, mitigation, and treatment of various disease states in critically ill populations. These diseases include antibiotic-associated diarrhea, Clostridium difficile diarrhea, ventilator-associated pneumonia, clearance of vancomycin-resistant enterococci from the GI tract, pancreatitis, liver transplant, major abdominal surgery, and trauma. However, their use has been severely limited due to a variety of factors including a general naïveté within the physician community, lack of regulation, and safety concerns. This article focuses on uses for probiotics in prevention and treatment, addresses current concerns regarding their use as well as proposing a protocol for safe use of probiotics in the critically ill patient.
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Affiliation(s)
- Lindsay M Urben
- Department of Pharmacy, University of Louisville Hospital, Louisville, KY, USA
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236
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Abstract
The incidence and severity of Clostridium difficile infection (CDI) have dramatically increased in the Western world in recent years. In contrast, CDI is rarely reported in China, possibly due to under-diagnosis. This article briefly summarizes CDI incidence, management and preventive strategies. The authors intend to raise awareness of this disease among Chinese physicians and health workers, in order to minimize the medical and economic burden of a potential epidemic in the future.
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Affiliation(s)
- Xinhua Chen
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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237
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Affiliation(s)
- Nick Daneman
- Division of Infectious Diseases and Clinical Epidemiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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238
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Smith K. Therapy: Probiotics do not reduce antibiotic-associated or Clostridium difficile diarrhoea in older hospitalized patients. Nat Rev Gastroenterol Hepatol 2013; 10:566. [PMID: 23982682 DOI: 10.1038/nrgastro.2013.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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