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

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.