Impact of adding prophylactic probiotics to a bundle of standard preventative measures for Clostridium difficile infections: enhanced and sustained decrease in the incidence and severity of infection at a community hospital.

BACKGROUND: In 2003, hospitals in Quebec, Canada experienced an increase of NAP1/027 Clostridium difficile infections following antibiotic administration (CDIAA). At Pierre-Le Gardeur Hospital (PLGH), the incidence increased from 10 to over 25 cases per 1000 patient admissions. METHODS: We report a quasi-experimental, prospective cohort study evaluating the effect on CDIAA of a probiotic added to existing C. difficile infection (CDI) standard preventative measures (SPM) in 31,832 hospitalized patients receiving antibiotics. Phase I (1580) measured the impact of SPM alone. In Phase II, 50 to 60 × 10(9) cfu daily dose of oral Lactobacillus acidophilus CL1285 and L. casei LBC80R probiotic formula (Bio-K+) was administered to all patients receiving antibiotics. Phase III included the same intervention after a move to a new hospital facility. Phases II and III included 4968 patients. During Phase IV, 25,284 patients were submitted to the same regimen but outcome data were compared to those of similar hospitals in Quebec. RESULTS: At the end of Phase III, CDIAA had decreased from more than 18 cases per 1000 patient admissions in Phase I to less than 5 cases. Reductions of CDI cases (73%) (p < 0.001) and severe CDI cases (76.4%) (p < 0.001) were observed. CDI recurrence rate was reduced by 39% (p < 0.001). During the following 6 years, the CDI rate averaged 2.71 cases per 10,000 patient-days at PLGH compared to 8.50 cases per 10,000 patient-days in equivalent hospitals located in Quebec. STUDY LIMITATION: This study is not a randomized clinical trial; it is an open prospective study and should be treated as such. Also, following Phase II, PLGH moved into a new facility and this could have contributed to lower CDI. CONCLUSIONS: Specific probiotic product added to SPM and antibiotic stewardship activities resulted in a further reduction in CDI rates and was shown to be safe.

Isolation and characterization of three cDNAs coding for Rab proteins from the albumen gland of the mollusc Lymnaea stagnalis.

Three cDNA clones encoding small GTP-binding proteins, LS-Rab1, LS-Rab2 and LS-Rab18a were isolated from a cDNA library from the albumen gland of the pulmonate snail Lymnaea stagnalis. Comparison of the deduced amino acid sequences with available sequences from the EMBL/Data Bank revealed that LS-Rab1 and LS-Rab2 show a sequence identity of 89-90% to the mammalian Rab1 and Rab2 proteins, and can therefore be regarded as the L. stagnalis homologs. LS-Rab18a may be considered a new member of the Rab subfamily, closely related to mouse Rab18 (74% amino acid identity). Interestingly, LS-Rab1 and LS-Rab2 share a very high sequence conservation with their mammalian homologs (95-97%) over the first 178-191 N-terminal amino acids, whereas the C-terminal part is almost completely divergent, except for their extreme ends (2-4 amino acids). The implications of these observations for the understanding of Rab-targeting signals are discussed. The LS-rab cDNAs were expressed in COS-7M6 cells. The resulting 22-kDa products were shown to bind GTP. In the albumen gland mRNA, levels of LS-rab1 appeared to be much higher than those of LS-rab2 and LS-rab18a, suggesting an important role for the LS-Rab1 protein in the albumen gland.