Microbial Preparations (Probiotics) for the Prevention of Clostridium difficile Infection in Adults and Children: An Individual Patient Data Meta-analysis of 6,851 Participants
Autor: | Lawrence Mbuagbauw, Ruzha Pancheva, Behnam Sadeghirad, Gary Foster, Joshua Z. Goldenberg, Li Wang, Dominik Mertz, Agostino Colli, Duolao Wang, Mark A. Miller, Bradley C. Johnston, Mary Hickson, Stephen Allen, Sandra Hirsch, Christian P. Selinger, Anna M. Maw, Calvin Ka-Fung Lo, Pietro Pozzoni, Lehana Thabane, Elisabet Lönnermark, Stephan Ehrhardt, John S. Sampalis, Samford Wong, Lyubov Lytvyn, Sue Plummer, Bengt Klarin, Hania Szajewska, Deniz Güney Duman |
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Přispěvatelé: | Johnston, Bradley C., Lytvyn, Lyubov, Lo, Calvin Ka-Fung, Allen, Stephen J., Wang, Duolao, Szajewska, Hania, Miller, Mark, Ehrhardt, Stephan, Sampalis, John, Duman, Deniz G., Pozzoni, Pietro, Colli, Agostino, Lonnermark, Elisabet, Selinger, Christian P., Wong, Samford, Plummer, Susan, Hickson, Mary, Pancheva, Ruzha, Hirsch, Sandra, Klarin, Bengt, Goldenberg, Joshua Z., Wang, Li, Mbuagbaw, Lawrence, Foster, Gary, Maw, Anna, Sadeghirad, Behnam, Thabane, Lehana, Mertz, Dominik |
Rok vydání: | 2018 |
Předmět: |
Microbiology (medical)
Adult Male medicine.medical_specialty Adolescent Epidemiology Placebo-controlled study DIAGNOSIS law.invention 03 medical and health sciences DOUBLE-BLIND Young Adult 0302 clinical medicine Randomized controlled trial APPROPRIATE law Risk Factors Internal medicine medicine ANTIBIOTIC-ASSOCIATED DIARRHEA Humans 030212 general & internal medicine Adverse effect Child SACCHAROMYCES-BOULARDII Aged Randomized Controlled Trials as Topic OUTCOMES Cross Infection business.industry Probiotics Infant Odds ratio Middle Aged EFFICACY Confidence interval Anti-Bacterial Agents Infectious Diseases Meta-analysis Child Preschool Clostridium Infections 030211 gastroenterology & hepatology TRIAL Female Antibiotic-associated diarrhea business CONSENSUS BURDEN |
Zdroj: | Infection control and hospital epidemiology. 39(7) |
ISSN: | 1559-6834 0899-823X |
Popis: | OBJECTIVETo determine whether probiotic prophylaxes reduce the odds ofClostridium difficileinfection (CDI) in adults and children.DESIGNIndividual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors.METHODSWe searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality.RESULTSProbiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25–0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23–0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11–4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is ≥5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89–1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89–1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness.CONCLUSIONSModerate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is ≥5%.TRIAL REGISTRATIONPROSPERO 2015 identifier: CRD42015015701Infect Control Hosp Epidemiol2018;771–781 |
Databáze: | OpenAIRE |
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