USE OF PROBIOTICS IN PREVENTING ANTIBIOTIC ASSOCIATED DIARRHOEA AND CLOSTRIDIUM DIFFICILE ASSOCIATED DIARRHOEA IN SPINAL INJURY CENTRES: AN INTERNATIONAL MULTICENTRE SURVEY

摘要

Probiotics may prevent antibiotic-associated-and Clostridium difficile-associated- diarrhoea (AAD/CDAD). Many spinal cord injury centres (SCICs) practitioners consider probiotics generically and may not realise that efficacy can be strain-, dose-, anddisease-specific. One to four SCICs per country (depending on population size) were contacted (UK:4; the Netherlands:3; Belgium: 1; Republic of Ireland: 1) to (a) determine if they stocked probiotics; (b) determine whether the use of those probiotics was evidence-based; and (c) document their C. difficile infection (CDI) practices. All nine SCICs responded to the survey (7 physicians, 3 microbiologists, 1 nurie and 2 dietitians). Five (55.5%) stocked probiotics; five1 different probiotics were identified. Four probiotics were preferred choice prevention of AAD/CDAD were Lactobacillus casei Shirota (44.4%), L. casei DN-114001 (22.2%), L. acidophilus (22.2%) and a mixed-strains probiotic (Ecologic Pro-AD) (11.1%). Only one evidence base study was identified supporting the use of probiotic for prevention ofAAD in SCI patients. Mean CDI cases per 10,000patient-days were 0.307 (s.d: 0.486, range 0.00 to 1.08). Definitions of diarrhoea and CDI varied among SCICs. Stocking probiotics for the prevention ofAADI CDAD is not common. There is only one single study showing efficiency of a particular strain in SCI populations. The study highlighted the importance of using a standardised definition of diarrhoea when conducting AADI CDAD research.