The effect of probiotics on the incidence of Clostridioides difficile: Retrospective cohort analysis

Published:October 10, 2019DOI:


      • Those on probiotics had a higher risk of Clostridioides difficile infection (CDI).
      • Use of proton pump inhibitors or histamine 2 receptor antagonists increased CDI.
      • Sex and age did not have a significant impact on incidence of CDI.
      • Time of probiotic initiation to antibiotic administration had no impact on CDI.
      • Number of concurrent antibiotics significantly increased risk for incidence of CDI.


      Conflicting evidence exists regarding probiotics and the incidence of Clostridioides difficile infection (CDI). This study evaluates whether probiotics are efficacious for CDI prophylaxis in patients receiving antibiotics.


      A retrospective cohort analysis of patients admitted to NYU Winthrop Hospital who received at least 1 dose of antibiotics considered high risk of inducing CDI. Patients were grouped according to probiotic use; association between probiotic use and incident CDI was examined. A model for incident CDI adjusting for known CDI risk factors was estimated.


      Of 3,267 patients, 4.6% had CDI within 12 weeks of antibiotics initiation. A total of 5.1% received probiotics within 24 hours of initiation, and 6.6% initiated probiotics during the 12-week follow-up. Of those taking probiotics within 24 hours of antibiotics, 9.6% had CDI, and of those not taking probiotics 4.2% had CDI (relative risk, 2.3; 95% confidence interval, 1.4, 3.7). In time-dependent Cox models accounting for probiotic initiation and adjusting for potential confounders, a positive association between probiotics and CDI remained significant (hazard ratio, 2.7; P < .001).


      Patients who received antibiotics with concurrent probiotics were more likely to have an incident of CDI compared with those who did not receive probiotics. Additional risk factors were histamine 2 receptor antagonists, proton pump inhibitors, and administration of multiple antibiotics simultaneously.


      The present study, because of its large population and inclusion of multiple variables playing a role in CDI, serves as a valuable resource when considering efficacy of probiotics as CDI prophylaxis.

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      Linked Article

      • Re: Saltzman et al study on probiotics and prevention of CDI-the importance of probiotic strain specificity
        American Journal of Infection ControlVol. 48Issue 3
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          In a recent retrospective study by Saltzman et al published in this journal, it was reported probiotics were found to be ineffective for the primary prevention of Clostridium. difficile infections (CDI).1 The authors gathered a 10% sample of patients who had been given antibiotics at high risk for CDI who either taken one of 2 types of probiotics (Lactobacillus acidophilus or Saccharomyces boulardii) or no probiotics. They did report the sample of patients who took any probiotic were significantly older and had been given more multiple antibiotics than the control group.
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