A Lactobacillus casei Shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries: a randomised controlled trial. Issue 4 (28th February 2014)

• Record Type: Journal Article
• Authors: Wong, Samford; Jamous, Ali; O'Driscoll, Jean; Sekhar, Ravi; Weldon, Mike; Yau, Chi Y.; Hirani, Shashivadan P.; Grimble, George; Forbes, Alastair
• Is Part Of: British journal of nutrition. Volume 111:Issue 4(2014)
• Page Start: 672
• Page End: 678
• Publication Date: 2014-02-28
• Subjects: Nutrition -- Periodicals; 572.4
• DOI: 10.1017/S0007114513002973
• Languages: English
• ISSNs: 0007-1145

Abstract

<abstract abstract-type="normal"> <title> <x content-type="archive" xml:space="preserve">Abstract</x> </title> <p>Certain probiotics may prevent the development of antibiotic-associated diarrhoea (AAD) and <italic>Clostridium difficile</italic>-associated diarrhoea (CDAD), but their effectiveness depends on both strain and dose. There are few data on nutritional interventions to control AAD/CDAD in the spinal cord injury (SCI) population. The present study aimed to assess (1) the efficacy of consuming a commercially produced probiotic containing at least 6·5 × 10<sup>9</sup> live <italic>Lactobacillus</italic><italic>casei</italic> Shirota (LcS) in reducing the incidence of AAD/CDAD, and (2) whether undernutrition and proton pump inhibitors (PPI) are risk factors for AAD/CDAD. A total of 164 SCI patients (50·1 (<sc>sd</sc> 17·8) years) with a requirement for antibiotics (median 21 d, range 5–366) were randomly allocated to receive LcS (<italic>n</italic> 76) or no probiotic (<italic>n</italic> 82). LcS was given once daily for the duration of the antibiotic course and continued for 7 days thereafter. Nutritional risk was assessed by the Spinal Nutrition Screening Tool. The LcS group had a significantly lower incidence of AAD (17·1 <italic>v</italic>. 54·9 %, <italic>P</italic>< 0·001). At baseline, 65 % of patients were at undernutrition risk. Undernutrition (64·1 <italic>v</italic>. 33·3 %, <italic>P</italic>< 0·01) and the use of PPI (38·4 <italic>v</italic>. 12·1 %, <italic>P</italic>= 0·022) were found to be associated with AAD. However, no significant difference was observed in nutrient intake between the groups. The multivariate logistic regression analysis identified poor appetite ( < 1/2 meals eaten) (OR 5·04, 95 % CI 1·28, 19·84) and no probiotic (OR 8·46, 95 % CI 3·22, 22·20) as the independent risk factors for AAD. The present study indicated that LcS could reduce the incidence of AAD in hospitalised SCI patients. A randomised, placebo-controlled study is needed to confirm this apparent therapeutic success in order to translate into improved clinical outcomes.</p> </abstract>