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Wong S, Hirani SP, Forbes A, Kumar N, Hariharan R, O'Driscoll J, Sekhar R, Jamous A. Lactobacillus casei Shirota probiotic drinks reduce antibiotic associated diarrhoea in patients with spinal cord injuries who regularly consume proton pump inhibitors: a subgroup analysis of the ECLISP multicentre RCT. Spinal Cord 2024; 62:255-263. [PMID: 38519563 PMCID: PMC11176055 DOI: 10.1038/s41393-024-00983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
STUDY DESIGN This was a sub-group analysis of a multicentre, randomised, placebo-controlled, double-blind trial (ECLISP trial) OBJECTIVES: To assess the efficacy of a probiotic containing at least 6.5 × 109 live Lactobacillus casei Shirota (LcS) in preventing antibiotic associated diarrhoea (AAD) in patients with spinal cord injury (SCI) who consumed proton pump inhibitor (PPI) regularly. LcS or placebo was given once daily for the duration of an antibiotic course and continued for 7 days thereafter. The trial was registered with ISRCTN:13119162. SETTING Three SCI centres (National Spinal Injuries Centre, Midland Centre for Spinal Injuries and Princess Royal Spinal Cord Injuries Centre) in the United Kingdom METHODS: Between November 2014, and November 2019, 95 eligible consenting SCI patients (median age: 57; IQ range: 43-69) were randomly allocated to receive LcS (n = 50) or placebo (n = 45). The primary outcome is the occurrence of AAD up to 30 days after finishing LcS/placebo. RESULTS The LcS group had a significantly lower incidence of AAD at 30 days after finishing the antibiotic course (28.0 v 53.3%, RR: 95% CI: 0.53, 0.31-0.89; z = 2.5, p = 0.01). Multivariate logistic regression analysis identified that LcS can reduce the risk of AAD at 30 days (OR: 0.36, 95% CI 0.13, 0.99, p < 0.05). No intervention-related adverse events were reported during the study. CONCLUSIONS LcS has the potential to prevent AAD in what could be considered a defined vulnerable group of SCI patients on regular PPI. A confirmatory, randomised, placebo-controlled study is needed to confirm this apparent therapeutic success to translate it into appropriate clinical outcomes. SPONSORSHIP Yakult Honsha Co., Ltd.
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Affiliation(s)
- Samford Wong
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
- School of Health & Psychological Sciences, City, University of London, London, UK.
- Royal Buckinghamshire Hospital, Aylesbury, UK.
| | - Shashivadan P Hirani
- School of Health & Psychological Sciences, City, University of London, London, UK
| | - Alastair Forbes
- University of Tartu, Estonia, and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Naveen Kumar
- Midland Centre for Spinal Injury, Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, UK
| | - Ramaswamy Hariharan
- The Princess Royal Spinal Injuries Centre, Northern General Hospital, Sheffield, UK
| | - Jean O'Driscoll
- Department of Microbiology, Stoke Mandeville Hospital, Aylesbury, UK
| | - Ravi Sekhar
- Department of Gastroenterology, Stoke Mandeville Hospital, Aylesbury, UK
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Motamedi H, Fathollahi M, Abiri R, Kadivarian S, Rostamian M, Alvandi A. A worldwide systematic review and meta-analysis of bacteria related to antibiotic-associated diarrhea in hospitalized patients. PLoS One 2021; 16:e0260667. [PMID: 34879104 PMCID: PMC8654158 DOI: 10.1371/journal.pone.0260667] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Antibiotic-associated diarrhea (AAD) is a major hospital problem and a common adverse effect of antibiotic treatment. The aim of this study was to investigate the prevalence of the most important bacteria that cause AAD in hospitalized patients. MATERIALS AND METHODS PubMed, Web of Science and Scopus databases were searched using multiple relevant keywords and screening carried out based on inclusion/exclusion criteria from March 2001 to October 2021. The random-effects model was used to conduct the meta-analysis. RESULTS Of the 7,377 identified articles, 56 met the inclusion criteria. Pooling all studies, the prevalence of Clostridioides (Clostridium) difficile, Clostridium perfringens, Klebsiella oxytoca, and Staphylococcus aureus as AAD-related bacteria among hospitalized patients were 19.6%, 14.9%, 27%, and 5.2%, respectively. The prevalence of all four bacteria was higher in Europe compared to other continents. The highest resistance of C. difficile was estimated to ciprofloxacin and the lowest resistances were reported to chloramphenicol, vancomycin, and metronidazole. There was no or little data on antibiotic resistance of other bacteria. CONCLUSIONS The results of this study emphasize the need for a surveillance program, as well as timely public and hospital health measures in order to control and treat AAD infections.
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Affiliation(s)
- Hamid Motamedi
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Matin Fathollahi
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ramin Abiri
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepide Kadivarian
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mosayeb Rostamian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amirhooshang Alvandi
- Medical Technology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Wong S, Hirani SP, Forbes A, Kumar N, Hariharan R, O'Driscoll J, Viswanathan A, Harvey G, Sekhar R, Jamous A. A study into the effect of Lactobacillus casei Shirota in preventing antibiotic associated diarrhoea including Clostridioides difficile infection in patients with spinal cord injuries: a multicentre randomised, double-blind, placebo-controlled trial. EClinicalMedicine 2021; 40:101098. [PMID: 34541475 PMCID: PMC8435694 DOI: 10.1016/j.eclinm.2021.101098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Antibiotic Associated Diarrhoea (AAD) and Clostridioides Difficile Infection (CDI) are of major concern in spinal cord injury (SCI) rehabilitation. METHODS A multi-centre, randomized, double-blind, placebo-controlled (the ECLISP) trial, was conducted in three tertiary spinal cord injury centre in the UK to assess the efficacy of consuming a probiotic beverage containing at least 6.5 × 109 live Lactobacillus casei Shirota (LcS) in preventing AAD and CDI and in patients with SCI and to determine whether proton pump inhibitors (PPI) and under nutrition-risk are risk factors for AAD/CDI. LcS or placebo was given once daily for the duration of an antibiotic course and continued for 7 days thereafter. Follow up was set at 7 and 30 days after the antibiotic course finished. The primary outcome was occurrence of AAD up to 30 days after finishing LcS/placebo. This trial is completed and registered (ISRCTN:13119162). FINDINGS Between November 2014, and November 2019, 359 consenting adult SCI patients (median age: 53.3; range: 18-88 years), from 3 SCI centres responsible for providing approximate 45-50% of UK SCI service, with a requirement for antibiotics due to infection were randomly allocated to receive LcS (n = 181) or placebo (n = 178). Overall, no statistical difference was seen in occurrence of the primary outcomes of AAD at 30 days follow up (45% v 42.1%, RR: 1.071, 0.8-1.4, p = 0.639). In the secondary analyses LcS was associated with a lower risk of AAD at 7 (19% v 35.7%, RR: 0.53, 0.29-0.99, p = 0.040) and 30 days follow up (28% v 52.2%, RR: 0.54, 0.32-0.91, p = 0.015) in the participants who took PPI regularly. Under nutrition-risk was associated with an increased risk of AAD at 7 (RR: 1.76, 1.28-2.44) and 30 days follow up (RR: 1.69, 1.30-2.0). No intervention-related adverse events were reported during the study. INTERPRETATION The present study indicates that LcS could not prevent AAD/CDI in unselected SCI patients. LcS might have the potential to prevent AAD in the higher risk group of patients on regular PPI. Confirmatory studies are needed to allow translation of this apparent therapeutic success into improved clinical outcomes. FUNDING Yakult Honsha Co., Ltd.
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Affiliation(s)
- Samford Wong
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Rd, United Kingdom
- School of Health Sciences, City, University of London, London, United Kingdom
- Royal Buckinghamshire Hospital, Aylesbury, United Kingdom
- Corresponding address: Dr Samford Wong, National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, HP21 8AL, UK.
| | | | - Alastair Forbes
- University of Tartu, Estonia, and Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Naveen Kumar
- Midland Centre for Spinal Injury, Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, United Kingdom
| | - Ramaswamy Hariharan
- The Princess Royal Spinal Injuries Centre, Northern General Hospital, Herries Rd, United Kingdom
| | - Jean O'Driscoll
- Department of Microbiology, Stoke Mandeville Hospital, Mandeville Rd, United Kingdom
| | - Anand Viswanathan
- The Princess Royal Spinal Injuries Centre, Northern General Hospital, Herries Rd, United Kingdom
| | - Graham Harvey
- Midland Centre for Spinal Injury, Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, United Kingdom
| | - Ravi Sekhar
- Department of Gastroenterology, Stoke Mandeville Hospital, Mandeville Rd, United Kingdom
| | - Ali Jamous
- Royal Buckinghamshire Hospital, Aylesbury, United Kingdom
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Liu B, Reid J, Silverman M, Welk B. High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections. Neurourol Urodyn 2020; 39:2401-2408. [PMID: 32902908 DOI: 10.1002/nau.24502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/17/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
AIM To characterize the use of common urinary tract infections (UTI)-relevant antibiotics after an SCI and determine the risk of Clostridium difficile infection (CDI) from these antibiotics. METHODS We used routinely collected data from Ontario (Canada) to conduct a retrospective, cohort study. We identified people >18 years of age with a traumatic SCI between April 2003 and March 2017. The primary exposure was an outpatient UTI-relevant antibiotic prescription during our observation period, and the primary outcome was evidence of a CDI. An adjusted cox proportional hazards model was used, and antibiotic exposure was modeled as a categorical, time-varying variable based on whether the patient likely had a UTI or not. RESULTS We identified 2528 people with SCI; 1642 (65%) were exposed at least once to an antibiotic of interest. The most commonly prescribed UTI-relevant antibiotic was fluoroquinolone (34%). Most patients did not have investigations for a UTI before the use of any of the different antibiotic classes. A small number of patients (5%) used chronic (>3 months) UTI-relevant antibiotics. The overall proportion of patients diagnosed with CDI was 7.4% (9.3/10 000 patient-days). The adjusted hazard ratio for CDI within 30 days was 3.5 (95% confidence interval, 1.9-6.7, p < .01) if they were exposed to a UTI-relevant antibiotic likely associated with a UTI, which was similar to the risk from UTI-relevant antibiotics which may not have been for a UTI. CONCLUSIONS The rate of CDI is high in this population and outpatient antibiotics that are commonly used for UTIs are a significant risk factor for CDI.
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Affiliation(s)
- Bonnie Liu
- Department of Surgery, Western University, London, ON, Canada
| | | | - Michael Silverman
- Division of Infectious Diseases, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Blayne Welk
- Department of Surgery, Western University, London, ON, Canada.,ICES, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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Dai W, Yang T, Yan L, Niu S, Zhang C, Sun J, Wang Z, Xia Y. Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China. BMC Infect Dis 2020; 20:277. [PMID: 32293302 PMCID: PMC7157987 DOI: 10.1186/s12879-020-05014-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI), especially hospital-acquired Clostridium difficile infection (HA-CDI), continues to be a public health problem and has aroused great concern worldwide for years. This study aimed to elucidate the clinical and epidemiological features of HA-CDI and the characteristics of C.difficile isolates in Chongqing, Southwest China. METHODS A case-control study was performed to identify the clinical incidence and risk factors of HA-CDI. C. difficile isolates were characterised by polymerase chain reaction (PCR) ribotyping, multilocus sequence typing (MLST), toxin gene detection and antimicrobial susceptibility testing. RESULTS Of the 175 suspicious patients, a total of 122 patients with antibiotic-associated diarrhea (AAD) were included in the study; among them, 38 had HA-CDI. The incidence of AAD and HA-CDI was 0.58 and 0.18 per 1000 patient admissions, respectively. Chronic renal disease and cephalosporin use were independent risk factors for HA-CDI. Fifty-five strains were assigned into 16 sequence types (STs) and 15 ribotypes (RTs). ST2/RT449 (8, 14.5%) was the predominant genotype. Of the 38 toxigenic isolates, A + B + CDT- isolates accounted for most (34, 89.5%) and 1 A + B + CDT+ isolate emerged. No isolate was resistant to vancomycin, metronidazole or tigecycline, with A-B-CDT- being more resistant than A + B + CDT-. CONCLUSIONS Different genotypes of C. difficile strains were witnessed in Chongqing, which hinted at the necessary surveillance of HA-CDI. Adequate awareness of patients at high risk of HA-CDI acquisition is advocated and cautious adoption of cephalosporins should be highlighted.
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Affiliation(s)
- Wei Dai
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Tianxiang Yang
- Department of Laboratory Medicine, Dianjiang People's Hospital of Chongqing, No.116 North Street, Guixi Street, Dianjiang County, Chongqing, 408300, People's Republic of China
| | - Li Yan
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Siqiang Niu
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Chuanming Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Jide Sun
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Zhu Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Yun Xia
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China.
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The Structure Features and Improving Effects of Polysaccharide from Astragalus membranaceus on Antibiotic-Associated Diarrhea. Antibiotics (Basel) 2019; 9:antibiotics9010008. [PMID: 31877915 PMCID: PMC7168208 DOI: 10.3390/antibiotics9010008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022] Open
Abstract
Astragalus membranaceus (Astragalus) is often used as a medical and food resource in China. The present study was designed to investigate the features and effects of polysaccharide from Astragalus membranaceus (WAP) on rats with antibiotic-associated diarrhea (AAD). WAP was mainly composed of glucose, galactose, arabinose and glacturonic acid, with glucan, arabinogalactan and RG-I regions, and it showed loosely irregular sheet conformation. WAP decreased the inflammatory cell infiltration of colon in AAD rats, increased propionate and butyrate production, improved metabolic levels, adjusted the diversity and composition of gut microbiota, increased the relative abundance of Pseudomonas, and decreased the relative abundance of Allobaculum and Coprococcus. In conclusion, WAP contained different types of polysaccharide regions and sheet three-dimensional conformation, while it ameliorated AAD by recovering the colon structure, adjusting the gut microbiota, and improving the SCFAs levels. The results can provide some data basis for natural products to alleviate the side effects related to antibiotics.
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Cadel L, C. Everall A, Hitzig SL, Packer TL, Patel T, Lofters A, Guilcher SJT. Spinal cord injury and polypharmacy: a scoping review. Disabil Rehabil 2019; 42:3858-3870. [DOI: 10.1080/09638288.2019.1610085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Amanda C. Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Science Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tanya L. Packer
- School of Occupational Therapy and Health Administration, Dalhousie University, Halifax, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Sara J. T. Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Rehabilitation Science Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- St. Michael’s Hospital, Centre for Urban Health Solutions, Toronto, Canada
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