Probiotic containing Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophiles (ACTIMEL) for the prevention of Clostridium difficile associated diarrhoea in the elderly with proximal femur fractures

Role of probiotics in preventing Clostridioides difficile infection in older adults: an integrative review

Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. This infection can particularly affect older adults, the most susceptible to CDI. Currently, the standard therapeutic measure is antibiotic therapy, which in turn increases the risk of recurrence of the infection by its collateral damage to the patient's microbiota. Probiotics are live microorganisms capable of maintaining balance in the intestinal microbiota. This study aims to perform an integrative review of the protective benefit of probiotics in CDI and diarrhea associated with C. difficile. The PubMed, Scopus, and Web of Science databases, the 10-year time cutoff, and the Prism Flow diagram were used for data collection. We observed no consensus among the studies; however, three of the seven evaluated studies demonstrated that the use of probiotics in older adults could contribute to reducing the incidence of hospital-onset CDI. We also found that the studies evaluated a wide variety of microorganisms, particularly Saccharomyces boulardii, associated with beneficial effects. More research is needed to understand the successful use of probiotics in the prevention of CDI in hospitalized older adults receiving antibiotics.

An exploration of alginate oligosaccharides modulating intestinal inflammatory networks via gut microbiota

Alginate oligosaccharides (AOS) can be obtained by acidolysis and enzymatic hydrolysis. The products obtained by different methods have different structures and physiological functions. AOS have received increasing interest because of their many health-promoting properties. AOS have been reported to exert protective roles for intestinal homeostasis by modulating gut microbiota, which is closely associated with intestinal inflammation, gut barrier strength, bacterial infection, tissue injury, and biological activities. However, the roles of AOS in intestinal inflammation network remain not well understood. A review of published reports may help us to establish the linkage that AOS may improve intestinal inflammation network by affecting T helper type 1 (Th1) Th2, Th9, Th17, Th22 and regulatory T (Treg) cells, and their secreted cytokines [the hub genes of protein-protein interaction networks include interleukin-1 beta (IL-1β), IL-2, IL-4, IL-6, IL-10 and tumor necrosis factor alpha (TNF-α)] via the regulation of probiotics. The potential functional roles of molecular mechanisms are explored in this study. However, the exact mechanism for the direct interaction between AOS and probiotics or pathogenic bacteria is not yet fully understood. AOS receptors may be located on the plasma membrane of gut microbiota and will be a key solution to address such an important issue. The present paper provides a better understanding of the protecting functions of AOS on intestinal inflammation and immunity.

Reduced Clostridioides difficile infections in hospitalised older people through multiple quality improvement strategies

OBJECTIVES

To reduce infections with Clostridioides difficile (CDI) in geriatric patients by interventions easily implementable in standard clinical care.

METHODS

Prevalence and incidence of CDI between January 2015 and February 2020 were analysed (n = 25,311 patients). Pre-intervention status was assessed from April 2016 to March 2017 (n = 4,922). Between May 2017 and August 2019, a monocentric interventional crossover study (n = 4,655) was conducted including standard care and three interventions: (A) sporicidal cleaning of hospital wards, (B) probiotics and (C) improvement in personal hygiene for CDI patients. This was followed by a multicentric comparison of the interventional bundle (A + B + C) between September 2019 and February 2020 (n = 2,593) with the pre-intervention phase. In 98 CDI cases and matched controls individual risk factors for the development of CDI were compared.

RESULTS

Time series analyses of CDI cases revealed a reduction in the prevalence of CDI in all three participating centres prior to the multicentric intervention phase. In the monocentric phase, no effect of individual interventions on CDI prevalence was identified. However, an aggregated analysis of CDI cases comparing the pre-intervention and the multicentric phase revealed a significant reduction in CDI prevalence. Risk factors for the development of CDI included use of antibiotics, anticoagulants, previous stay in long-term care facilities, prior hospital admissions, cardiac and renal failure, malnutrition and anaemia.

CONCLUSIONS

The observed reduction in CDI may be attributed to heightened awareness of the study objectives and specific staff training. Individual interventions did not appear to reduce CDI prevalence. A further randomised trial would be necessary to confirm whether the bundle of interventions is truly effective.

Synthesis of N-Acetyllactosamine and N-Acetyllactosamine-Based Bioactives

N-Acetyllactosamine (LacNAc) or more specifically β-d-galactopyranosyl-1,4-N-acetyl-d-glucosamine is a unique acyl-amino sugar and a key structural unit in human milk oligosaccharides, an antigen component of many glycoproteins, and an antiviral active component for the development of effective drugs against viruses. LacNAc is useful itself and as a basic building block for producing various bioactive oligosaccharides, notably because this synthesis may be used to add value to dairy lactose. Despite a significant amount of information in the literature on the benefits, structures, and types of different LacNAc-derived oligosaccharides, knowledge about their effective synthesis for large-scale production is still in its infancy. This work provides a comprehensive analysis of existing production strategies for LacNAc and important LacNAc-based structures, including sialylated LacNAc as well as poly- and oligo-LacNAc. We conclude that direct extraction from milk is too complex, while chemical synthesis is also impractical at an industrial scale. Microbial routes have application when multiple step reactions are needed, but the major route to large-scale biochemical production will likely lie with enzymatic routes, particularly those using β-galactosidases (for LacNAc synthesis), sialidases (for sialylated LacNAc synthesis), and β-N-acetylhexosaminidases (for oligo-LacNAc synthesis). Glycosyltransferases, especially for the biosynthesis of extended complex LacNAc structures, could also play a major role in the future. In these cases, immobilization of the enzyme can increase stability and reduce cost. Processing parameters, such as substrate concentration and purity, acceptor/donor ratio, water activity, and temperature, can affect product selectivity and yield. More work is needed to optimize these reaction parameters and in the development of robust, thermally stable enzymes to facilitate commercial production of these important bioactive substances.

Role of Probiotics, Prebiotics, and Synbiotics in the Elderly: Insights Into Their Applications

Elderly people are an important part of the global population who suffer from the natural processes of senescence, which lead to changes in the gut microbiota composition. These modifications have a great impact on their quality of life, bringing a general putrefactive and inflammatory status as a consequence. Some of the most frequent conditions related to this status are constipation, undernutrition, neurodegenerative diseases, susceptibility to opportunistic pathogens, and metabolic disbalance, among others. For these reasons, there is an increasing interest in improving their quality of life by non-invasive treatments such as the consumption of probiotics, prebiotics, and synbiotics. The aim of the present mini-review is to describe the benefits of these functional supplements/food according to the most recent clinical and pre-clinical studies published during the last decade. In addition, insights into several aspects we consider relevant to improve the quality of future studies are provided.

Effects of therapeutic probiotics on modulation of microRNAs

Probiotics are beneficial bacteria that exist within the human gut, and which are also present in different food products and supplements. They have been investigated for some decades, due to their potential beneficial impact on human health. Probiotics compete with pathogenic microorganisms for adhesion sites within the gut, to antagonize them or to regulate the host immune response resulting in preventive and therapeutic effects. Therefore, dysbiosis, defined as an impairment in the gut microbiota, could play a role in various pathological conditions, such as lactose intolerance, gastrointestinal and urogenital infections, various cancers, cystic fibrosis, allergies, inflammatory bowel disease, and can also be caused by antibiotic side effects. MicroRNAs (miRNAs) are short non-coding RNAs that can regulate gene expression in a post-transcriptional manner. miRNAs are biochemical biomarkers that play an important role in almost all cellular signaling pathways in many healthy and disease states. For the first time, the present review summarizes current evidence suggesting that the beneficial properties of probiotics could be explained based on the pivotal role of miRNAs. Video Abstract.

The in vitro Effects of the Probiotic Strain, Lactobacillus casei ZX633 on Gut Microbiota Composition in Infants With Diarrhea

We investigated the in vitro effects of Lactobacillus casei ZX633 on gut microorganism composition in infants with diarrhea. For this purpose, 103 feces samples from healthy infants (healthy group) and 300 diarrhea samples from infants (diarrhea group) were collected, and diarrhea feces were treated with L. casei ZX633, which was previously isolated from healthy infant feces (treatment group). We used microbial dilution plate methods, high performance liquid chromatography (HPLC) and high-throughput sequencing approaches to analyze viable main microorganism counts, short chain fatty acid (SCFA) concentrations, and intestinal microbiota composition in feces, respectively. Our data showed that L. casei ZX633 supplementation increased the numbers of Escherichia coli, yeasts, lactic acid bacteria (LAB) and aerobic-bacteria, raised propionic acid levels but reduced four other SCFAs, which are close to the healthy group. Alpha diversity results indicated that microbial diversity and richness decreased in treatment group. Bacterial community analyses revealed that microbial structures of the treatment group tended toward the healthy group; i.e., Escherichia-Shigella and Clostridioides abundance increased, and there was a reduction in the abundance of Streptococcus, Bacteroides, Enterococcus and Veillonella. In conclusion, L. casei ZX633 isolated from healthy infant feces, may be effective in improving infant diarrhea microbiota, potentially providing a new probiotic strain to reduce the incidence of diarrhea associated with bacterial disease in infants.

Bio-functional properties of probiotic Lactobacillus: current applications and research perspectives

Lactic acid bacteria as a starter culture are very important component in the fermentation process of dairy and food industry. Application of lactic acid bacteria as probiotic bacteria adds more functionality to the developed product. Gut colonizing bacteria have attractive benefits related to human health. Bio-functional properties such as antimicrobial activity, anti-inflammatory, ACE-inhibitory, antioxidant, antidiarrheal, antiviral, immunomodulatory, hypocholesterolemic, anti-diabetic and anti-cancer activities are the most applicable research areas of lactic acid bacteria. Different strains of Lactobacillus are generally consumed as probiotics and colonize the gastrointestinal tract. Sometimes these bacteria may possess antimicrobial activity and may positively influence the effect of antibiotics. Use of Lactobacillus spp. for the development of functional foods is one of the promising areas of current research and applications. Individual bacterial species have unique biological activity, which may vary from strains to strains and identification of this uniqueness could be helpful in the development of functional and therapeutic food products.

Lactobacillus sp as a Probiotic for the Prevention of Clostridium difficile Associated Diarrhea

Background: Antibiotic treatment can disturb the resistance of the gastrointestinal flora to colonization. This may result in complications, the most serious of which is Clostridium difficile associated diarrhea (CDAD). The aim of this study was to determine the effectiveness of probiotics for the prevention of CDAD.Method: The databases used were Scopus, Proquest, CINAHL, Medline, Pubmed and ScienceDirect, limited to having been published in the last 5 years. A literature review followed the keyword search. The keywords used were probiotics, Clostridium difficile, associated, diarrhea, randomized, control and trial using "AND" and “OR”. Twelve trials with 5102 participants were included. Eight trials reported a preventive effect for CDAD using a mixture of 2 strains of lactobacillus, a mixture of 4 combination strains, a mixture of lactobacillus and Saccharomyces or a mixture of Bifidobacterium, Lactobacillus and Saccharomyces.Result: Our findings indicate that probiotics may prevent CDAD. Most probiotics contain a singular strain. The combination with lactobacillus sp was the most effective at preventing CDAD.Conclusion: In addition, 6 out of 8 trials had an in relation to preventing CDAD containing lactobacillus sp. Four studies said that there were some factors that meant that the probiotic could not reduce or prevent the CDAD.

Infant dietary intake of yogurt and cheese and gastroenteritis at 1 year of age: The Japan Environment and Children's Study

BACKGROUND

The important role played by intestinal bacterial flora in human health has recently attracted public attention worldwide. Although yogurt is thought to help in preventing the onset of gastroenteritis, this property has rarely been examined in epidemiological studies.

METHOD

This study analyzed data obtained by the Japan Environment and Children's Study. From a dataset of 103,062 pregnancies, 82,485 were selected for this analysis. Dietary intake of fermented foods (yogurt and cheese) in 1-year-old infants was assessed with a food frequency questionnaire. Parent-reported physician-diagnosed gastroenteritis in early childhood was determined from a questionnaire conducted when the child was 1 year old.

RESULT

The incidence of gastroenteritis was significantly lower in infants who consumed yogurt ≥ 7 and 3-6 times/week than in infants who consumed yogurt < 1 time/week in crude models (n = 82,485) and after adjustment for covariates (adjusted odds ratio [95% confidence interval], 0.78 [0.70-0.86] versus 0.82 [0.76-0.89], respectively; n = 65,051). Frequency of weekly cheese consumption was not associated with the incidence of gastroenteritis.

CONCLUSION

Consumption of yogurt, but not cheese, at 1 year of age was associated with a reduced risk of gastroenteritis. Further studies of this association, including interventional studies, are warranted.

Isolation of a Lactococcus lactis Strain Producing Anti-staphylococcal Bacteriocin

Bacteriocin is ribosomally synthesized by bacteria and inhibits closely related species. In this study we aimed at isolating lactic acid bacteria producing bacteriocin presenting anti-staphylococcal activity. A Lactococcus lactis strain was isolated from kimchi for the purpose and identified by 16S rRNA gene sequencing. As preliminary tests, optimal culture conditions, stabilities against heat, solvents, and enzymes treatments, and type of action (bacteriostatic or bactericidal) of the bacteriocin were investigated. The optimal culture conditions for production of the bacteriocin were MRS broth medium and 25℃ and 30℃ culture temperatures. The bacteriocin was acidic and the activity was abolished by a protease treatment. Its stability was maintained at 100℃ for 15 min and under treatments of various organic solvents such as methanol, ethanol, acetone, acetonitrile, and chloroform. Finally, the bacteriocin showed bactericidal action against Staphylococcus aureus where 200 AU/mL of the bacteriocin decreased the viable cell count (CFU/mL) of S. aureus by 2.5 log scale, compared with a control (no bacteriocin added) after 4-h incubation.

Utility of Probiotics for Maintenance or Improvement of Health Status in Older People - A Scoping Review

OBJECTIVE

To evaluate the available evidence on probiotic use in older adults from human studies.

DESIGN

systematic review.

METHODS

The databases Embase, CINAHL and Medline were searched in December of 2017 for studies in humans where probiotics were used to modify a health outcome in older people. The quality of studies was evaluated using the Critical Appraisal Skills Program (CASP) assessment tool and the Cochrane Risk of Bias Assessment tool.

PARTICIPANTS

Subjects aged over sixty years either through specified selection criteria or where the mean participant age was greater than sixty.

INTERVENTIONS

Probiotic supplements.

MEASUREMENTS

Pre-specified clinically measurable health outcomes in age related conditions.

RESULTS

1210 articles were identified. After quality assessment and selection criteria were applied, 33 articles were identified to be included for review. As these studies cover a variety of applications and used customised protocols accordingly, meta-analysis was not possible and synthesis is in narrative form.

CONCLUSIONS

A growing body of research has applied commercially available probiotic preparations across care settings for age related conditions including gut dysmotility, osteoporosis, common infectious diseases and cognitive impairment. Although methodologies vary, randomised controlled trials have reproduced results in these areas, and so warrant consideration of probiotics as a low risk adjuvant treatment for specific indications in the elderly.

Oral Administration of Probiotics Increases Paneth Cells and Intestinal Antimicrobial Activity

The huge amount of intestinal bacteria represents a continuing threat to the intestinal barrier. To meet this challenge, gut epithelial cells produce antimicrobial peptides (AMP) that act at the forefront of innate immunity. We explore whether this antimicrobial activity and Paneth cells, the main intestinal cell responsible of AMP production, are influenced by probiotics administration, to avoid the imbalance of intestinal microbiota and preserve intestinal barrier. Administration of Lactobacillus casei CRL 431 (Lc 431) and L. paracasei CNCM I-1518 (Lp 1518) to 42 days old mice, increases the number of Paneth cells on small intestine, and the antimicrobial activity against the pathogens Staphylococcus aureus and Salmonella Typhimurium in the intestinal fluids. Specifically, strong damage of the bacterial cell with leakage of cytoplasmic content, and cellular fragmentation were observed in S. Typhimurium and S. aureus. Even more important, probiotics increase the antimicrobial activity of the intestinal fluids at the different ages, from weaning (21 days old) to old age (180 days old). Intestinal antimicrobial activity stimulated by oral probiotics, do not influence significantly the composition of total anaerobic bacteria, lactobacilli and enterobacteria in the large intestine, at any age analyzed. This result, together with the antimicrobial activity observed against the same probiotic bacteria; endorse the regular consumption of probiotics without adverse effect on the intestinal homeostasis in healthy individuals. We demonstrate that oral probiotics increase intestinal antimicrobial activity and Paneth cells in order to strengthen epithelial barrier against pathogens. This effect would be another important mechanism by which probiotics protect the host mainly against infectious diseases.