Incidence Of Antibiotic-associated Diarrhea Research Articles

Polysaccharides of natural products alleviate antibiotic-associated diarrhea by regulating gut microbiota: a review.

Antibiotic-associated diarrhea (AAD) is diarrhea caused by disturbances in intestinal microbiota and metabolism following inappropriate use of antibiotics. With the over-reliance on antibiotics, the incidence of AAD is increasing worldwide. Recently, the role of probiotics and prebiotic preparations in the prevention and treatment of AAD has received increasing attention. Various prebiotics can not only reduce the incidence of AAD, but also effectively shorten the course of the disease and alleviate the symptoms. Notably, many polysaccharides derived from plants and fungi are a class of biologically active and rich prebiotics with great potential to alleviate AAD. Therefore, this review aims to summarize the latest research on natural product polysaccharides to alleviate antibiotic-associated diarrhea by modulating the gut microbiota. It provides a theoretical basis for exploring the mechanism of natural product modulation of gut microbiota to alleviate AAD, and provides a reference for further development of active prebiotics.

A prospective randomized controlled study on probiotics for the prevention of antibiotic-associated diarrhea in infants and young children

To evaluate the preventive effects of Saccharomyces boulardii powder and tetragenous viable Bifidobacterium tablets on antibiotic-associated diarrhea (AAD) in infants and young children. Children under three years old admitted to the Department of Pediatrics, Affiliated Hospital of Xuzhou Medical University due to non-gastrointestinal infections and requiring antibiotic treatment from July to December 2023 were enrolled. The children were randomly divided into a control group (n=47), a Saccharomyces boulardii group (n=70), and a Bifidobacterium group (n=65) using a random number table method. The control group received antibiotics and symptomatic supportive treatment according to relevant clinical guidelines. In addition to the treatment given to the control group, the Saccharomyces boulardii group and the Bifidobacterium group were respectively administered with Saccharomyces boulardii powder and tetragenous viable Bifidobacterium tablets. Based on the duration of probiotic use (7 days, 14 days, and 21 days), the Saccharomyces boulardii group was further divided into 7 d, 14 d, and 21 d subgroups, and similarly for the Bifidobacterium group. The incidence of AAD and ratio of cocci to bacilli in feces were compared among the groups after treatment. The incidence rate of AAD in both the Saccharomyces boulardii group and the Bifidobacterium group was lower than that in the control group (P<0.017). The duration of AAD and the length of hospital stay were shorter in the Saccharomyces boulardii and Bifidobacterium groups compared to the control group (P<0.05). In the control group, the ratio of cocci to bacilli in feces on days 7, 14, and 21 was higher than on day 1 (P<0.05). Within-group comparisons showed that the ratio of cocci to bacilli in feces on day 14 in the Bifidobacterium 14 d and 21 d groups were lower than on day 1 (P<0.05); and the ratios on day 14 in the control group, Saccharomyces boulardii 14 d group, Saccharomyces boulardii 21 d group, Bifidobacterium 14 d group, and Bifidobacterium 21 d group were lower than on day 7 (P<0.05). The ratios on day 21 in the control group and the Saccharomyces boulardii 21 d group were lower than on days 7 and 14 (P<0.05). Between-group comparisons indicated that on day 7, the ratios of cocci to bacilli in feces in the Saccharomyces boulardii 7 d, 14 d, 21 d groups, and Bifidobacterium 7 d, 14 d, 21 d groups were all lower than in the control group (P<0.05); on day 14, the ratios of cocci to bacilli in feces 14 d and 21 d groups were lower than in the control group and the Bifidobacterium 7 d group (P<0.05). Both Saccharomyces boulardii and tetragenous viable Bifidobacterium can effectively improve gut microbiota and prevent the occurrence of AAD in infants and young children. Compared to short-term treatment, appropriately extending the duration of probiotic therapy can further improve the structure of gut microbiota.

Lactobacillus casei Shirota probiotic drinks reduce antibiotic associated diarrhoea in patients with spinal cord injuries who regularly consume proton pump inhibitors: a subgroup analysis of the ECLISP multicentre RCT

Study designThis was a sub-group analysis of a multicentre, randomised, placebo-controlled, double-blind trial (ECLISP trial)ObjectivesTo assess the efficacy of a probiotic containing at least 6.5 × 109 live Lactobacillus casei Shirota (LcS) in preventing antibiotic associated diarrhoea (AAD) in patients with spinal cord injury (SCI) who consumed proton pump inhibitor (PPI) regularly. LcS or placebo was given once daily for the duration of an antibiotic course and continued for 7 days thereafter. The trial was registered with ISRCTN:13119162.SettingThree SCI centres (National Spinal Injuries Centre, Midland Centre for Spinal Injuries and Princess Royal Spinal Cord Injuries Centre) in the United KingdomMethodsBetween November 2014, and November 2019, 95 eligible consenting SCI patients (median age: 57; IQ range: 43-69) were randomly allocated to receive LcS (n = 50) or placebo (n = 45). The primary outcome is the occurrence of AAD up to 30 days after finishing LcS/placebo.ResultsThe LcS group had a significantly lower incidence of AAD at 30 days after finishing the antibiotic course (28.0 v 53.3%, RR: 95% CI: 0.53, 0.31–0.89; z = 2.5, p = 0.01). Multivariate logistic regression analysis identified that LcS can reduce the risk of AAD at 30 days (OR: 0.36, 95% CI 0.13, 0.99, p < 0.05). No intervention-related adverse events were reported during the study.ConclusionsLcS has the potential to prevent AAD in what could be considered a defined vulnerable group of SCI patients on regular PPI. A confirmatory, randomised, placebo-controlled study is needed to confirm this apparent therapeutic success to translate it into appropriate clinical outcomes.SponsorshipYakult Honsha Co., Ltd.

688. Risk of Clostridioides difficile Infection and Antibiotic Associated Diarrhea in Patients Receiving Outpatient Parenteral Antimicrobial Therapy

Abstract Background The colonic microbiome plays a critical role in resisting the ingrowth of pathogenic microbes like Clostridioides difficile (C. difficile). Disruption of the microbiome by antibiotics is known to cause antibiotic-associated diarrhea (AAD) and C. difficile infection (CDI). Outpatient parenteral antimicrobial therapy (OPAT) reduces hospital length of stay and exposure to healthcare-associated pathogens which may decrease the incidence of CDI. Previous studies that compared patients who received metronidazole for non-CDI indications with those who did not found a reduction in CDI among patients who received metronidazole. The aim was to study the incidence of AAD and CDI in the OPAT patient population and compare the incidence rate between patients who received oral metronidazole for non-CDI indications with those who did not. Methods We retrospectively reviewed a cohort from our facility's OPAT program. We included adult patients (18 years or older) discharged to home or skilled nursing facility (SNF) on OPAT over a 2-year time span, regardless of diagnosis. Pregnant patients, patients with active CDI before starting OPAT, and those who were receiving an associated CDI treatment were excluded. Antibiotic-associated diarrhea was defined as 3 or more loose or watery stools per day with negative CDI testing or spontaneous improvement after stopping antibiotics. Community-onset and healthcare facility–associated CDI (CO-HCFA CDI) was defined as 3 or more watery stools per day with a positive stool C. difficile diagnostic test in the community or within the first 3 days of readmission, provided the diagnosis was made less than 4 weeks since discharge from a healthcare facility. Demographics of Patients Discharged on OPAT. Patients selected between June 1, 2018 and June 2020, grouped by whether or not they developed Clostridioides difficile infection (CDI). SD= standard deviation; Q1= 1st quartile; Q3= 3rd quartile. Results Of the 617 charts that met inclusion criteria, 31 had AAD and 3 had CO-HCFA CDI. Incidence of CO-HCFA CDI was &amp;lt; 1%; &amp;lt; 1 per 1000 person-day and incidence of AAD was 5.02%. The protective role of metronidazole could not be studied due to the rarity of CDI in this study. Patients with positive CDI after initiation of OPAT and associated characteristics. Conclusion Although our study was not able to answer our initial question when comparing the effect of metronidazole within OPAT groups and rates of CDI, our data is promising for showing low rates of CDI in patients receiving OPAT. This study demonstrates the putative benefits of OPAT with reduced CDI incidence regardless of use of anti-CDI drugs. Disclosures Tirdad Zangeneh, DO, AiCuris: Grant/Research Support

Incidence and Risk Factors for Antibiotic-associated Diarrhea Among Hospitalized Children.

We aimed to evaluate the incidence, clinical findings, and risk factors of antibiotic-associated diarrhea (AAD) in hospitalized children without known comorbid diseases. All hospitalized children during the 1-year period that fulfilled the inclusion criteria were included in this study (n = 358). AAD was defined as; ≥2 loose or watery stools per day for a minimum of 24 hours during antibiotic treatment caused by Clostridioides difficile or negative stool tests for identifiable infectious agents. During hospitalization, diarrhea developed in 32 (8.93%) of the 358 patients. C. difficile toxin B was positive for 1 case. No infectious agents were detected in 21 patients. Overall, AAD was observed in 22 patients (6.14%, 95% CI: 4.09-9.13). Male sex ( P = 0.027, OR: 3.36), age between 1 month and <3 years ( P = 0.01, OR: 4.23), ibuprofen use ( P = 0.044, OR: 2.63) and late administration of antibiotics ( P = 0.001, OR: 9.5) were associated with the development of AAD. The incidence of AAD is low among hospitalized children without comorbid diseases, and most diarrheal episodes are mild and self-limiting. The use of probiotics in this patient group may be limited to certain specific situations.

685: EFFICACY OF LACTOBACILLUS GG FOR PREVENTION OF ANTIBIOTIC ASSOCIATED DIARRHEA IN THE PICU

Introduction: Antibiotic associated diarrhea (AAD) is a common adverse effect in pediatric patients. Previous meta-analysis on probiotic use for AAD have reported that lactobacillus GG (LGG) has potential for more protective effects compared to other strains of probiotics. There is limited data on the use of LGG for the prophylaxis of AAD in the pediatric intensive care unit (PICU) where there is frequent use of broad-spectrum antibiotics. The objective of this study was to assess the efficacy of LGG to prevent AAD in the PICU. Methods: This prospective randomized, double-blind, placebo-controlled trial occurred in a 15-bed PICU. Inclusion criteria was age ≤ 17 years and required antibiotic therapy ≥ 72hrs. Exclusion criteria included but was not limited to antibiotics ≥ 48 hrs prior, prior probiotics, pre-existing diarrhea, laxative therapy, immunocompromise, and GI disorders. Treatment with LGG (30 x 109 CFU) or a matching placebo capsule was administered twice daily, initiated within 24 hours of starting antibiotic therapy and continued for the duration of therapy. Diarrhea was defined as stools >200 mL or 200 g per day in a patient over 10 kg and > 20 mL/kg/day or > 20 g/kg/day in a patient < 10 kg or 3 or more loose stools in 24 hours. Patients that experienced diarrhea > 72 hours were crossed over. The primary outcome was the incidence of AAD in the LLG versus placebo groups. Potential adverse effects were monitored daily. Statistics were conducted with SPSS. Results: Thirty-one patients met the initial inclusion/exclusion criteria and were enrolled in the study. Nineteen patients were eligible for final analysis with 9 in the LGG group and 10 in the placebo group. Mean age was 0.96±1.3 and 4.7±6.4 years for the LGG and placebo groups, respectively. Mean weight was 6.95±4.21 and 22.76±29.38 kg for LGG and placebo groups, respectively. 30% vs 70% of patients experienced diarrhea in the LGG groups vs placebo (p=0.35). The median length of stay for the patients with AAD was 7.5 days compared to 6 days in placebo group (p=0.093). The odds ratio for AAD was 0.29 [95%CI 0.039-2.11]. No adverse events were reported or attributed to LGG. Conclusions: Results of this study indicate that LGG is safe and effective in reducing the incidence of AAD in the critically ill pediatric patients at our institution.

Effects of Irrational Use of Antibiotics on Intestinal Health of Children with Extraintestinal Infectious Diseases.

The effects of different antibiotic treatment regimens on intestinal function and flora distribution in children with extraintestinal infectious diseases are explored. A total of 150 cases of extraintestinal infectious diseases admitted to our hospital from January 2021 to January 2022 and 50 healthy subjects during the same period were selected for the study. These 150 children were randomly divided into cephalosporin group, piperacillin group, and combined group and were successively treated with ceftazidime, piperacillin, and two drug combination regimens. The efficacy of the drug, intestinal microflora, intestinal mucosal barrier function, and incidence of antibiotic-associated diarrhea (AAD) were compared among the different groups. The experimental results showed that ceftazidime combined with piperacillin can effectively improve the intestinal health of children with extraintestinal infectious diseases but destroy the microecological environment of intestinal flora, affect the intestinal mucosal barrier function, and increase the risk of AAD.

INFLUENCE OF IRRATIONAL PRESCRIPTION OF ANTIBACTERIAL THERAPY ON THE PROGNOSIS OF TREATMENT AND SURVIVAL IN PATIENTS WITH COVID-19

IIntroduction. The COVID-19 pandemic became a major challenge for healthcare systems around the world. The development and improvement of basic treatments for coronavirus patients is important to improve public health and improve quality of life after recovery. The aim of the study: to determine the frequency and structure of prescribing antibacterial drugs in the prehospital and hospital stages, used in patients with COVID-19. Assess the relationship between irrational use of antibacterial drugs with the length of hospital stay of patients with coronavirus disease, the risk of transfer to the intensive care unit (ICU) and mortality. Materials and methods: Statistical, retrospective analysis of 400 case histories of patients with COVID-19 who were treated at the Municipal Non-Profit Enterprise «Kyiv City Clinical Hospital №17» (KNP «KMKL#17») for the period from September 2020 to November 2021 with severe coronavirus disease. Results: 400 medical charts were selected for the study, which were divided into two groups according to the purpose of antibacterial therapy. Of the group of patients who received pre-hospital antibacterial therapy (200 people), indications for its appointment had only 7 % of patients. Among the group receiving antibacterial drugs there is a prolongation of the length of stay in the hospital, the risk of transfer to ICU increases. There is also higher risk of mortality in patients of group 1 (14,5 %), compared with group 2 (8 %), whose antibacterial drugs were not prescribed at the prehospital stage. Conclusion: as a result of the study it was found that patients who were unreasonably prescribed antibacterial therapy prolongs the period of general hospitalization by 2.3 ± 0.8 days, increasing the need for transfer of patients due to deterioration to ICU by an average of 13 %, increase in the incidence of antibiotic-associated diarrhea by 7-8 %, and there is a tendency to increase mortality from COVID-19. Antibacterial drugs should be used only on the basis of indications in the case of proven bacterial co-infection (superinfection) or reasonable suspicion of it in patients with respiratory disease caused by SARS-CoV-2 and in no case should be prophylactic.

Approaches to prevention of antibiotic-associated diarrhea in children

The incidence of antibiotic-associated diarrhea, according to various authors, ranges from 5 to 39% and depends on the patient’s age and other contributing factors. Antibiotic-associated diarrhea can be caused by any antibiotic, regardless of dosage form or route of administration. In the pediatric population, the prevalence of antibiotic-associated diarrhea ranges from 6 to 70%. An urgent problem is the development of this disease against the background of a course of H. pylori eradication therapy, which significantly complicates tolerance and adherence to therapy. This article presents current data on the pathogenesis and risk factors of antibiotic-associated diarrhea in children. The clinical picture ranges from idiopathic enteritis to antibiotic-associated diarrhea caused by Cl. difficile - pseudomembranous colitis.The main principle of antibiotic-associated diarrhea treatment is cancellation of the antibacterial medicine that caused the diarrhea, or reducing its dose (if the course of the disease allows it). In complex treatment sorbents are used, correction of water-electrolyte balance is carried out. The use of probiotics seems quite logical for the treatment and prevention of antibiotic-associated diarrhea in terms of the pathogenesis of this condition. To correct dysbiosis, drugs are used to maintain and restore the quantitative and qualitative composition of the intestinal microbiota.Taking into account modern recommendations the main groups of drugs (probiotics, prebiotics, synbiotics) used for correction of intestinal microbiocenosis are presented. The mechanism of action of probiotics and mechanisms of their effect on intestinal microflora are considered. The basic requirements for bacterial strains that are part of the probiotic drugs are presented.The results of various randomized clinical trials and meta-analyses confirming the necessity of including probiotic complexes in antibiotic-associated diarrhea treatment regimens are presented from an evidence-based medicine perspective. The clinical effects of strains of Lactobacillusspp., Bifidobacterium spp.,Streptococcusspp. and Lactococcusspp. on the digestive tract microbiota are considered. The role of a synbiotic containing 9 probiotic strains of 4.5 * 109 CFU in one capsule and the prebiotic component fructooligosac-charides in the prevention of antibiotic-associated diarrhea in children is discussed separately. The results of microbiological studies confirmed the presence of microorganisms of genera Bifidobacterium, Lactobacillus, Streptococcus in the product, and the content of bacteria in one dose of the product was not less than 2 x 1010 CFU.

Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis

ObjectiveTo evaluate existing evidence for the use of probiotics in preventing antibiotic-associated diarrhoea (AAD) in adults.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).Data sourcesWe performed a literature search of...

Comparison of antibiotic-associated diarrhea caused by cefoperazone/sulbactam or piperacillin/tazobactam in neurosurgery patients.

ObjectiveTo compare the occurrence and prognosis of antibiotic-associated diarrhea (AAD) between patients treated with cefoperazone/sulbactam and piperacillin/tazobactam in the neurosurgery department.MethodsThis study retrospectively analyzed patients who received cefoperazone/sulbactam or piperacillin/tazobactam to prevent or treat hospital-acquired infections in the Department of Neurosurgery of The First Medical Center of Chinese PLA General Hospital between October 2019 and October 2020. For patients with AAD, clinical data, antibiotic usage, the incidence of diarrhea, treatment, and prognosis were collected and analyzed.ResultsIn total, 356 patients were enrolled, and 65 (18.6%) experienced AAD, 38 patients in the cefoperazone/sulbactam group and 27 patients in the piperacillin/tazobactam group. The AAD rate did not differ between the treatment arms. Conversely, the dosage, intensity, and duration of antibiotic therapy differed between the groups, whereas no differences were noted in the time to the appearance of diarrhea and prognosis. According to regression analysis, the incidence of AAD did not differ between the groups (odds ratio [OR] = 0.85, 95% confidence interval [CI] = 0.46–1.48).ConclusionCefoperazone/sulbactam or piperacillin/tazobactam can lead to a similar incidence rate of AAD. The combined application of antibiotics and empiric therapy often occurs. The rational use of antibiotics should be improved.

Modern approaches to the prevention and rehydration therapy of antibiotic-associated diarrhea affected by ARI in children

The use of antibiotic drugs (ABDs) has significantly reduced the number of severe bacterial infectious diseases and mortality in children, especially in infants. But the widespread and unnecessary use of ABDs, including reserve antibiotics (the use of carbapenems increased by 45%, polymyxins – by 13%), to treat uncomplicated acute respiratory infections is open to many hazards, such as increased antibiotic resistance of pathogens. Antibiotic-associated diarrhea is one of the common complications of antibiotic therapy. According to various authors, the incidence of antibiotic-associated diarrhea is 6–80% among patients treated with antibiotics, on average 35% of patients (approximately every third patient) receiving antibiotics report symptoms of antibiotic-associated diarrhea. Disruptive changes in the qualitative and quantitative composition of the intestinal microbiota are accompanied by a decrease in the protective functions of the intestinal mucosa and contribute to the growth of pathogenic and opportunistic microorganisms (Clostridium spp., Candida spp., Salmonella spp., Staphyloccus aureus). The findings of most studies obtained on a large sample of paediatric population, as well as the clinical guidelines of the World Association of Gastroenterologists recommend the use of L. rhamnosus GGprobiotic strain (level of evidence 1) to prevent antibiotic-associated diarrhea in children. L. rhamnosus GGpresents chromosomal resistance to a range of antibiotics, which varies with species and strain. They do not contain plasmid DNA, which is dangerous for the spread of antibiotic resistance among other bacteria, which enables their wide therapeutic and prophylactic use. Clinical case studies of the course of antibiotic-associated diarrhea in children are presented to demonstrate the variability of clinical symptoms. Fever in children with ARI, particularly in tender-age infants, requires special attention from parents and doctors, as its main risk lies with a dehydration due to significant water loss during breathing, and especially increased sweating (including sweating induced by antipyretics). Therefore, oral rehydration therapy is an important method for treating infectious diseases in children. Complications that develop in patients, especially in children, after administration of antibiotics, diseases that can lead to water and electrolyte imbalance are life-threatening conditions that require immediate medical attention. Correction of water and electrolyte balance, timely restoration of intestinal microflora improve prognosis in such patients and promote faster recovery.

Antibiotic associated diarrhoea in paediatric outpatient practice

Background: To document the profile of antibiotic associated diarrhoea (AAD) in children aged 6 months to 15 years receiving oral antibiotics.Methods: Prospective study of children attending the out-patient department, who were started on oral antibiotic for indications other than gastrointestinal infections. Data collection was done with a questionnaire and follow up was done by telephone.Results: Of the 1022 children, seven developed AAD (0.68%). Twenty-nine other children had loose stools but did not fulfil the criteria of AAD. Of 436 children who received Amoxicillin clavulanate, 4 developed AAD. One each from 361 on amoxicillin, 9 on ciprofloxacin and 8 on erythromycin developed AAD. Five of the seven children who had diarrhoea were less than two years (71.4%).Conclusions: Incidence of AAD is very low in an out-patient setting. In all cases, diarrhoea subsided on stopping the antibiotic. Children below two years of age and those on Amoxicillin clavulanate have a significantly higher risk.

Probiotics for the Prevention of Antibiotic-associated Diarrhea in Adults: A Meta-Analysis of Randomized Placebo-Controlled Trials.

Objective:This meta-analysis aims to combine the latest research evidence to assess the effect of probiotics on preventing antibiotic-associated diarrhea (AAD) in adults.Methods:PubMed, Cochrane Library, EMBASE, and Web of Science were searched for randomized placebo-controlled trials on probiotics preventing AAD. A random or fixed effect model was used to combine the incidence of AAD (primary outcome) and the adverse event rates. The authors performed subgroup analyses to explore the effects of different participants population, probiotics species, and dosage.Results:Thirty-six studies were included with 9312 participants. Probiotics reduced the incidence of AAD by 38% (pooled relative risk, 0.62; 95% confidence interval, 0.51-0.74). The protective effect of probiotics was still significant when grouped by reasons for antibiotics treatment, probiotic duration, probiotic dosage, and time from antibiotic to probiotic. However, there were no statistically significant increased adverse events in the probiotics group (relative risk, 1.00; 95% confidence interval, 0.87-1.14).Conclusions:This updated meta-analysis suggested that using probiotics as early as possible during antibiotic therapy has a positive and safe effect on preventing AAD in adults. Further studies should focus on the optimal dosage and duration of probiotics to develop a specific recommendation.

Systematic Review: Lactobacilli and/or bifidobacteria in Preventing Antibiotics Associated Diarrhoea and C. Difficile Infection in Adults

Background: The rate of Antibiotic Associated Diarrhoea (AAD) and Clostridium difficile associated diarrhoea (CDAD) have increased among hospitalized patients who are on long term of antibiotics therapy. Probiotics when combined with the usual treatment found to decrease the incidence rate of these cases. This systematic review evaluates the effectiveness of lactobacilli-based probiotics alone and multistrains of lactobacilli and bifido bacteria in AAD and CDAD. Methods: Three databases: Google Scholar; PubMed and Cochrane central library were covered for randomized controlled trials from period 2005 till 2017. Studies were examined and filtered according to title/abstract and full text. The quality of included studies was assessed using Jadad scale. Results: Eight articles were reviewed. Four articles investigated the use of various strains of lactobacilli-based probiotics among adult hospitalized patients who had already started antibiotics therapy. These showed that lactobacilli-based probiotics alone are effective in reducing both AAD and CDAD. Two of the studies used similar strains and similar doses, both resulted in significant reduction in diarrhoeal cases (OR 0.34; P=0.05) and (OR 0.667; P=0.067), respectively. While the other two studies showed less significance among hospitalized patients (OR 0.25 P=0.007, P< 0.001). The other four articles investigated the use of lactobacilli probiotics in combination with bifodobacteria strains. Two studies were conducted on large number of patients using different doses of probiotics. Results showed these probiotics were not effective, AAD (P=0.71) and CDAD (P=0.35). One study showed the incidence of AAD was lower when higher dose of probiotics was used (P=0.08) while no difference in CDAD (P=0.02). The last study showed that patients who received Infloran(multistrainprobiotics) developed AAD and CDAD more than placebo group (P=0.246). Conclusion: This review showed that lactobacilli-based probiotics alone are more effective in reducing AAD and CDAD than multistrain probiotics. More researches that involve large number of patients and use lactobacilli strains only are needed to imply its use in clinical settings.

Antibiotic Associated Diarrhea in Hospitalized Adult Patien

Background: Antibiotic associated diarrhea (AAD) occurs from the first initiation until 2 months of the end of antibiotic treatment. The aims of this study were to know the incidence of AAD, Clostridium difficile infectionand other gastrointestinal symptoms in hospitalized adult patients.Method: The study is a cross sectional study. We studied the antibiotic associated diarrhea (AAD), Clostridiumdifficile infection and other gastrointestinal symptoms in patients who were admited in Cipto Mangunkusumo Hospital. Inclusion were male or female, age 18-75 years old, patients started receiving antibiotics maximal 2x 24 hours prior to hospitalization, gave written informed consent.Results: The incidence of AAD was 11.5%. The incidence of Clostridium difficile infection was 15.4%. The upper gastrointestinal symptom was present on 20 (38.5%) patients. Lower abdominal symptom was present on 10 (19.2%) patients.Conclusion: The Incidence of AAD and Clostridium difficile infection were 11.5% and 15.4% respectively.The clinical manifestations of AAD were diarrhea, other upper and lower abdominal symptoms.

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

BackgroundClostridium difficile infection (CDI), especially hospital-acquired Clostridium difficile infection (HA-CDI), continues to be a public health problem and has aroused great concern worldwide for years. This study aimed to elucidate the clinical and epidemiological features of HA-CDI and the characteristics of C.difficile isolates in Chongqing, Southwest China.MethodsA case-control study was performed to identify the clinical incidence and risk factors of HA-CDI. C. difficile isolates were characterised by polymerase chain reaction (PCR) ribotyping, multilocus sequence typing (MLST), toxin gene detection and antimicrobial susceptibility testing.ResultsOf the 175 suspicious patients, a total of 122 patients with antibiotic-associated diarrhea (AAD) were included in the study; among them, 38 had HA-CDI. The incidence of AAD and HA-CDI was 0.58 and 0.18 per 1000 patient admissions, respectively. Chronic renal disease and cephalosporin use were independent risk factors for HA-CDI. Fifty-five strains were assigned into 16 sequence types (STs) and 15 ribotypes (RTs). ST2/RT449 (8, 14.5%) was the predominant genotype. Of the 38 toxigenic isolates, A + B + CDT- isolates accounted for most (34, 89.5%) and 1 A + B + CDT+ isolate emerged. No isolate was resistant to vancomycin, metronidazole or tigecycline, with A-B-CDT- being more resistant than A + B + CDT-.ConclusionsDifferent genotypes of C. difficile strains were witnessed in Chongqing, which hinted at the necessary surveillance of HA-CDI. Adequate awareness of patients at high risk of HA-CDI acquisition is advocated and cautious adoption of cephalosporins should be highlighted.

Do probiotics prevent antibiotic-associated diarrhoea? Results of a multicentre randomized placebo-controlled trial

Antibiotic-associated diarrhoea (AAD) is a side-effect of antibiotic consumption and probiotics have been shown to reduce AAD. A multicentre, double-blind, placebo-controlled, randomized trial was conducted to evaluate the role of Lactobacillus casei DN114001 (combined as a drink with two regular yoghurt bacterial strains) in reducing AAD and Clostridioides difficile infection in patients aged over 55 years. The primary outcome was the incidence of AAD during 2 weeks of follow-up. A total of 1127 patients (mean age ± standard deviation: 73.6 ± 10.5) were randomized to the active group (N= 549) or placebo group (N= 577). Both groups were followed up as per protocol. The proportion of patients experiencing AAD during follow-up was 19.3% (106/549) in the probiotic group vs 17.9% (103/577) in the placebo group (unadjusted odds ratio 1.10, 95% confidence interval 0.82-1.49, P= 0.53). No significant evidence was found of a beneficial effect of the specific probiotic formulation in preventing AAD in this elderly population drawn from a number of different UK hospitals. However, in the UK and in many other healthcare systems there have, in recent years, been many changes in antibiotic stewardship policies, an overall decrease in incidence in C.difficile infection, as well as an increased awareness of infection prevention, and modifications in nursing practice. In light of these factors, it is impossible to conclude definitively from the current trial that the study-specific probiotic formulation has no role in preventing AAD, and it is our view that further trials may be indicated, controlling for these variables.

The Effectiveness of Synbiotics in Preventing Antibiotic-Associated Diarrhea in Children: A Double-Blind Randomized Clinical Trial

Background: Antibiotic-associated diarrhea (AAD) is of great concern in children due to the wide range of antibiotic administration among this population. Studies considering the use of synbiotics for prevention or treatment of AAD are limited. In the current study, the effectiveness of synbiotics in preventing AAD was investigated. Methods: This randomized, double-blinded clinical trial was conducted on 100 patients undergoing antibiotic therapy for over five days. The patients were randomly divided into a case group receiving synbiotic therapy (Protexin; The United Kingdom) and a control group undergoing placebo therapy (consisting of starch sachets). Both groups began their medication within 24 hours after antibiotic initiation and continued it for further seven days after antibiotic therapy cessation. The two groups were compared regarding the incidence of diarrhea, stool consistency based on the Bristol Stool Scale (BSS), and the duration of diarrhea. Results: The members of case and control groups were not statistically different regarding age, gender distribution, length of hospitalization, the frequency of defecation, and stool consistency based on BSS before antibiotic therapy, primary and final diagnosis, the type of antibiotics prescribed, and duration of antibiotic therapy (P > 0.05). The incidence of AAD was significantly less in the case group compared with the control group (P = 0.016), while those with AAD did not show significant difference regarding the duration of diarrhea, stool consistency based on BSS, and the frequency of defecation a day (P = 0.51, 0.26, and 0.18, respectively). Conclusions: The findings of this study showed that early initiation of synbiotics and its long-term administration following antibiotic therapy cessation could considerably prevent AAD; however, in case of AAD occurrence synbiotic therapy cannot positively affect duration, stool consistency, and the frequency of defecation.

SYSTEMS APPROACH FOR ANTIBIOTICS IN COLORECTAL SURGERY IN GROWING ANTIMICROBIAL RESISTANCE BACKGROUND

AIM: to reduce antibiotic resistance of infectious agents in colorectal surgery using optimal antibiotic therapy. PATIENTS AND METHODS: single-center interventional study with retrospective control has been done. Start point of intervention was January 2017, when it was provided direct administrative control of perioperative antibiotic prophylaxis protocols and empirical antibiotic therapy. The study included 200 patients after colorectal surgery in 2016-2017. Patients divided in two groups: in 2016 y – control (A), in 2017 – interventional one (B). RESULTS: significant decrease was detected in total antibiotic use from 16.1 to 12.2 defined daily dose (DDD) and in duration of antibiotic prophylaxis from 5.5 to 1.9 days (p&lt;0.001). Incidence of infection caused by multi-resistant strains reduced from 84.3% to 50% (p&lt;0.001). Analysis of etiology septic complications in colorectal patients showed a decrease in the number of Enterobacteriales, producing extended-spectrum beta-lactamases (ESBL) from 33.3% to 11.8% (р&lt;0.01). The incidence of carbapenem-resistant Klostridium pneumoniae reduced from 7.8% до 0%, р=0.031. ESKAPE group pathogens decreased from 24 (47.1%) to 12 (17.7%), р&lt;0.001. No difference in postoperative infectious morbidity between groups was detected (32.9% vs 31.0%, р=0.88). Incidence of antibiotic-associated diarrhea decreased from 5% to 0% (р=0.03). CONCLUSION: direct control of antibiotic prophylaxis protocols and empirical antibiotic therapy allowed to decrease the rate of antibiotic use and to decrease rate of infection complications caused by antibiotic resistance strains.