P0525 - Efficacy and Safety of Probiotics for Prevention of Clostridioides difficile Diarrhea in the Older Adult Population: A Systematic Review and Meta-Analysis

Sunday, October 22, 2023

3:30 PM - 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Oscar Hernandez, III, MD

Florida Atlantic University Charles E. Schmidt College of Medicine
Boca Raton, FL

Oscar Hernandez, MD¹, Muhammad Haider, MD¹, Azhar Hussain, MD², Charles Vallejo, MD¹, Talwinder Nagi, MD¹, Zoilo Suarez, MD¹, Fatima Ahson, MD¹
¹Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL; ²SUNY Upstate Medical University, New York, Syracuse, NY

Introduction: Per the World Health Organization, probiotics are live microorganisms that confer a significant health benefit to the host when administered in healthy amounts. Antibiotics-associated diarrhea (AAD) and Clostridioides difficile infection (CDI) remain prevalent issues in the older adult population (age > 65 years) due to factors such as impaired immune systems, increased antibiotics exposure, and use of acid-suppressing medications. Previous studies have proposed that probiotics are associated with reduced incidence of AAD and CDI, however, new studies have found conflicting evidence in the older adult population. Our study aimed at evaluating the efficacy and safety profile of probiotics amongst the older adult population.

Methods: A comprehensive literature search was performed using PubMed, Embase, Google Scholar, and Cochrane Library, using the terms: "probiotics," "Clostridioidies difficile infection," "elderly," and "randomized controlled trials" between the years 1995-2023. Inclusion criteria were: randomized controlled trials (RCTs) evaluating the use of probiotics for CDI prevention in older adults, studies reporting the incidence of CDI as a primary or secondary outcome, studies reporting adverse events related to probiotic use, and studies published in English. Studies that did not meet the above criteria were excluded.

Results: Seven studies were included with a total of 3,826 participants. In the pooled analysis, there was a significant reduction in the incidence of CDI in the probiotics group compared to the placebo group (RR 0.48, 95% CI 0.34-0.69, I2=65%). The use of probiotics was associated with reduced antibiotic duration for all-cause infections (RR 0.75, 95% CI 0.62-0.90, I2=31%). There was no significant difference in the adverse events incidence between the probiotics and placebo groups (RR 0.97, 95% CI 0.80-1.17, I2 = 28%). Subgroup analysis did not reveal a significant difference in the efficacy between probiotics.

Discussion: In the pooled analysis, probiotics were effective in reducing the incidence of CDI and AAD in older adults. However, the two largest and highest quality trials did not find this benefit. These findings demonstrate a need for further similar quality studies to evaluate the proposed benefit of probiotics seen in earlier studies. Further clinical trials comparing the efficacy of different probiotics and determining the optimal dosage should also be done, as this may ultimately affect how probiotics are utilized in the older adult population.

Figure: Forest Plot Analysis Plotting Odds Ratios between Probiotics and Placebo Groups Concerning Incidence of C. difficile Infection

Study	Study Design	Sample Size	Intervention	Comparison	Duration	Measured Outcome
Allen et al. (2013)	Randomized Control Trial	2,941	Lactobacilli and Bifidobacteria	Placebo	21 days	Incidence of antibiotic-associated diarrhea and C. difficile infection
Plummer et al. (2004)	Randomized Control Trial	50	Lactobacilli and Bifidobacteria	Placebo	28 days	Incidence of C. difficile infection
Rajkumar et al. (2020)	Randomized Control Trial	200	Lactobacilli and Streptococcus thermophilus	Placebo	14 days	Incidence of antibiotic-associated diarrhea
Butler et al. (2020)	Randomized Control Trial	310	Lactobacilli and Bifidobacteria	Placebo	12 weeks	Duration of Antibiotics use for all-cause infections
Safdar et al. (2008)	Randomized Control Trial	40	Lactobacillus	Placebo	14 days	Incidence of antibiotic-associated diarrhea
Lewis et al. (1998)	Randomized Control Trial	61	Saccharomyces boulardii	Placebo	14 days	Incidence of antibiotic-associated diarrhea
Zahroni et al. (2011)	Randomized Control Trial	194	Probiotic Mixture	Placebo	14 days	Incidence of diarrhea in hospitalized patients

Table: Characteristics of Included Studies

Disclosures:

Oscar Hernandez indicated no relevant financial relationships.

Muhammad Haider indicated no relevant financial relationships.

Azhar Hussain indicated no relevant financial relationships.

Charles Vallejo indicated no relevant financial relationships.

Talwinder Nagi indicated no relevant financial relationships.

Zoilo Suarez indicated no relevant financial relationships.

Fatima Ahson indicated no relevant financial relationships.

Oscar Hernandez, MD¹, Muhammad Haider, MD¹, Azhar Hussain, MD², Charles Vallejo, MD¹, Talwinder Nagi, MD¹, Zoilo Suarez, MD¹, Fatima Ahson, MD¹. P0525 - Efficacy and Safety of Probiotics for Prevention of Clostridioides difficile Diarrhea in the Older Adult Population: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.