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Feasibility of a Lactobacillus casei Drink in the Intensive Care Unit for Prevention of Antibiotic Associated Diarrhea and Clostridium difficile.

  • 2018-04-26
  • Nutrients 10(5)
    • Cathy Alberda
    • Sam Marcushamer
    • Tayne Hewer
    • Nicole Journault
    • Demetrios Kutsogiannis

Study Design

Type
Clinical Trial
Population
ICU patients initiated on antibiotics
Methods
Patients matched with contemporary controls; received two bottles daily of a drink containing 10 billion Lactobacillus casei bolused via feeding tube
Blinding
Open-label
Funding
Unclear
  • Rigorous Journal
Background: Over 70% of patients are prescribed antibiotics during their intensive care (ICU) admission. The gut microbiome is dramatically altered early in an ICU stay, increasing the risk for antibiotic associated diarrhea (AAD) and Clostridium difficile infections (CDI). Evidence suggests that some probiotics are effective in the primary prevention of AAD and CDI. Aim: To demonstrate safety and feasibility of a probiotic drink in ICU patients. Methods: ICU patients initiated on antibiotics were recruited, and matched with contemporary controls. Study patients received two bottles daily of a drink containing 10 billion Lactobacillus casei which was bolused via feeding tube. Tolerance to probiotics and enteral nutrition, development of adverse events, and incidence of AAD was recorded. CDI rates were followed for 30 days post antibiotic treatment. Results: Thirty-two patients participated in the trial. There were no serious adverse events in the probiotic group, compared to three in the control group. AAD was documented in 12.5% of the probiotic group and 31.3% in the control group. One patient in the probiotic group developed CDI compared to three in the control group. Discussion: A probiotic containing drink can safely be delivered via feeding tube and should be considered as a preventative measure for AAD and CDI in ICU.

Research Insights

  • Lactobacillus casei→Reduced Clostridium difficile Infection

    One patient in the probiotic group developed CDI compared to three in the control group.

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    two bottles daily of a drink containing 10 billion Lactobacillus casei
  • Lactobacillus casei→Reduced Diarrhea Rate

    AAD was documented in 12.5% of the probiotic group and 31.3% in the control group.

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    two bottles daily of a drink containing 10 billion Lactobacillus casei

Adverse Events Reported

  • Lactobacillus casei→Overall tolerability

    There were no serious adverse events in the probiotic group, compared to three in the control group.

    Finding
    Reported
    Severity
    Serious adverse event
  • Lactobacillus casei→serious adverse events

    There were no serious adverse events in the probiotic group, compared to three in the control group.

    Finding
    Reported
    Severity
    Serious adverse event
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