• 分析总计纳入6261人的19项研究的数据,使用益生菌组艰难梭菌感染(CDI)发生率为1.6%(54/3277),对照组为3.9% (115/2984);
  • 益生菌组患者中,CDI的合并相对风险为0.42;
  • 在第一次使用抗生素后,尽快使用益生菌明显更有效,2天内使用显著降低CDI风险,越往后一天,功效会递减;
  • 而对使用益生菌的病人来说,并不会增加不良事件的风险;
  • 纳入的研究中所用的益生菌菌株多样,本文特别列表说明。
蓝灿辉 | 热心肠先生
Gastroenterology [IF:22.682]

Timely use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: a Systematic Review with Meta-Regression Analysis



2017-02-09, Review

Abstract & Authors:展开

BACKGROUND & AIMS: Systematic reviews have provided evidence for the efficacy of probiotics in preventing Clostridium difficile infection (CDI), but guidelines do not recommend probiotic use for prevention of CDI. We performed an updated systematic review to help guide clinical practice.
METHODS: We searched MEDLINE, EMBASE, International Journal of Probiotics and Prebiotics, and The Cochrane Library databases for randomized controlled trials evaluating use of probiotics and CDI in hospitalized adults taking antibiotics. Two reviewers independently extracted data and assessed risk of bias and overall quality of the evidence. Primary and secondary outcomes, respectively, were incidence of CDI and adverse events. Secondary analyses examined the effects of probiotic species, dose, timing, formulation, duration, and study quality.
RESULTS: We analyzed data from 19 published studies, comprising 6261 subjects. The incidence of CDI in the probiotic cohort, 1.6% (54/3277), was lower than of controls, 3.9% (115/2984) (P<.001). The pooled relative risk of CDI in probiotic users was 0.42 (95% CI, 0.30-0.57; I(2)=0.0%). Meta-regression analysis demonstrated that probiotics were significantly more effective if given closer to the first antibiotic dose, with a decrement in efficacy for every day of delay in starting probiotics (P=.04); probiotics given within 2 days of antibiotic initiation produced a greater reduction of risk for CDI (relative risk, 0.32, 95% CI, 0.22-0.48; I(2)=0%) than later administration (relative risk 0.70, 95% CI, 0.40-1.23; I(2)=0%) (P=.02). There was no increased risk for adverse events among patients given probiotics. The overall quality of the evidence was high.
CONCLUSIONS: In a systematic review with meta-regression analysis, we found evidence that administration of probiotics closer to the first dose of antibiotic reduces the risk of CDI by more than 50% in hospitalized adults. Future research should focus on optimal probiotic dose, species, and formulation. Systematic Review Registration: PROSPERO CRD42015016395.

First Authors:
Nicole T Shen

Correspondence Authors:
Nicole T Shen

All Authors:
Nicole T Shen,Anna Maw,Lyubov L Tmanova,Alejandro Pino,Kayley Ancy,Carl V Crawford,Matthew S Simon,Arthur T Evans