Probiotics and prevention of Clostridium difficile infection.

The role of probiotics as adjunctive measures in the prevention of Clostridium difficile infection (CDI) has been controversial. However, a growing body of evidence has suggested that they have a role in primary prevention of CDI. Elements of this controversy are reviewed and the proposed mechanisms of action, the value and cost effectiveness of probiotics are addressed with a focus on three agents, Saccharomyces boulardii, Lactobacillus rhamnosus GG and the combination of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R, Lactobacillus rhamnosus CLR2 (Bio-K+).

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.

Systematic patients' hand disinfection: impact on meticillin-resistant Staphylococcus aureus infection rates in a community hospital.

The role of patients and their relatives as unidentified transient meticillin-resistant Staphylococcus aureus (MRSA) carriers and sources of dissemination in healthcare institutions has not been systematically addressed. Patients' and their relatives' hands may represent a substantial and 'unaccounted for' mode of transmission. This study aimed to verify this hypothesis in our 250-bed community hospital. The trial consisted of a systematic waterless washing and gel rinse disinfection of all patients' and visiting relatives' hands for a period of one year, along with retrospective comparison of the nosocomial infection rates. Under the supervision of infection control personnel, a team of four full-time and four part-time attendants was trained to meet all patients and visiting relatives and encourage them to clean their hands with an alcohol gel rinse twice a day on every weekday. Rates of MRSA infections per thousand admissions, cost-benefit analysis and staff hand hygiene compliance were audited throughout. From the comparative year, the rate of MRSA nosocomial infections per thousand admissions decreased by 51%. Assuming that the incidence of MRSA was maintained from comparative to study year, the intervention may have prevented 51 cases of MRSA infection and resulted in substantial savings. While focusing extensively on staff behaviour to prevent MRSA transmission, we may have overlooked hand hygiene practices by patients and their relatives as a potential mode of transmission. Systematic hand hygiene of patients and relatives appears to be an inexpensive and highly effective preventive measure against MRSA nosocomial transmission.

[Not Available]. / Listériose humaine : Expériences cliniques avec cette zoonose chez 12 patients en Estrie, Québec sur une période de 19 ans (1976 à 1995).

To review the epidemiology, risk factors, clinical features and outcomes of Listeria monocytogenes infection in the Eastern Townships of Quebec, a retrospective study was completed over the period 1976 to 1995. Cases were identified from positive cultures and diagnosis given by the infectious diseases service of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec. A total of 12 cases were in the study. Septicemia not related to pregnancy (four of 12) and meningitis (six of 12) were the major clinical presentations. There was one case of listeriosis associated with pregnancy and one case of granulomatosis infanti septica. Ten patients had at least one predisposing underlying condition. Only one death was related to L monocytogenes infection. Neurological sequelae were observed in half of the cases of meningitis, whereas no sequelae were noted in cases of septicemia. In conclusion, listeriosis is predominantly a disease of elderly and immunosuppressed patients. The clinical presentation and outcome are not different from those reported in other industrialized countries.