Evaluation of probiotics efficiency for the prevention of Clostridioides difficile infection in hospitalized patients: a systematic review and meta-analysis.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-06-10 DOI:10.1007/s15010-025-02580-2

Yahya A Almutawif, Mustafa A Najim, Najeeb Ullah Khan

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Abstract

Background: Clostridioides difficile infection (CDI) poses a significant healthcare challenge, with the most frequent cause being antibiotic-associated diarrhea, affecting hospitalized individuals with substantial cost and mortality concerns. However, there is no information regarding probiotic efficiency for initial CDI treatment, and the modulation of microbiota by probiotics has been suggested as a potential preventive measure against CDI.

Objective: To evaluate the efficacy of probiotics in preventing CDI in hospitalized patients.

Methods: An exhaustive literature search was performed using PubMed to identify controlled/clinical trials investigating the use of probiotics for CDI prevention among hospitalized individuals based on PRISMA guidelines and the PICO framework. Relevant data were extracted from selected studies. Statistical meta-analysis (subgroup or sensitivity analyses) was performed using R Studio to calculate the pooled effect size, odds ratio (OR) with a 95% CI, p-value, and heterogeneity. The risk of bias was assessed using the Cochrane risk-of-bias (RoB) tool to determine publication bias and sensitivity of the included studies.

Results: Four studies with a significant number of participants were identified and included in the meta-analysis. The incidence of CDI was reduced in the probiotic group compared to the placebo group, with an overall OR of 0.99 (95% CI [0.56; 1.7]), increased heterogeneity, and a non-significant p-value, using a random effects model in R Studio. Subgroup analysis suggested possible beneficial outcomes regarding the selection of probiotic strain and dose regimen, supporting the effective use of probiotics in preventing CDI. Two of the included studies showed a high risk of bias in the randomization process, while others indicated a significantly low risk of bias.

Conclusion: Detailed or systematic information on CDI treatment provides evidence that the direction of the odds ratio suggests a possible protective role of probiotics, although the overall effect was not significant. The OR < 1.0 indicates a neutral efficiency of probiotics, on CDI incidence observed in the probiotics group compared to the placebo group.

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评价益生菌预防住院患者艰难梭菌感染的有效性：系统回顾和荟萃分析。

背景：艰难梭菌感染（CDI）是一个重大的医疗保健挑战，最常见的原因是抗生素相关性腹泻，影响住院患者，具有大量的成本和死亡率问题。然而，目前还没有关于益生菌在CDI初期治疗中的效率的信息，益生菌调节微生物群被认为是一种潜在的预防CDI的措施。目的：评价益生菌预防住院患者CDI的疗效。方法：使用PubMed进行详尽的文献检索，以确定基于PRISMA指南和PICO框架的住院患者中使用益生菌预防CDI的对照/临床试验。从选定的研究中提取相关数据。使用R Studio进行统计荟萃分析（亚组或敏感性分析），计算合并效应大小、优势比（or）、95% CI、p值和异质性。使用Cochrane风险偏倚（RoB）工具评估偏倚风险，以确定纳入研究的发表偏倚和敏感性。结果：四项具有显著数量参与者的研究被确定并纳入meta分析。与安慰剂组相比，益生菌组的CDI发生率降低，总体OR为0.99 (95% CI [0.56；[1.7])，异质性增加，p值不显著，使用R Studio中的随机效应模型。亚组分析表明，益生菌菌株和剂量方案的选择可能带来有益的结果，支持益生菌在预防CDI中的有效使用。纳入的两项研究显示随机化过程中存在较高的偏倚风险，而其他研究显示偏倚风险明显较低。结论：关于CDI治疗的详细或系统的信息提供了证据，优势比的方向表明益生菌可能具有保护作用，尽管总体效果并不显著。的或

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.