A Lactobacillus casei Shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries: a randomised controlled trial. Issue 4 (18th September 2013)

• 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: 2013-09-18
• Subjects: Probiotics, -- Spinal cord injuries, -- Diarrhoea, -- Undernutrition risk; Nutrition -- Periodicals; 572.4
• DOI: 10.1017/S0007114513002973
• Languages: English
• ISSNs: 0007-1145

Abstract

Abstract : Certain probiotics may prevent the development of antibiotic-associated diarrhoea (AAD) and Clostridium difficile -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 9 live Lactobacillus casei 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 (sd 17·8) years) with a requirement for antibiotics (median 21 d, range 5–366) were randomly allocated to receive LcS ( n 76) or no probiotic ( n 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 v . 54·9 %, P < 0·001). At baseline, 65 % of patients were at undernutrition risk. Undernutrition (64·1 v . 33·3 %, P < 0·01) and the use of PPI (38·4 v . 12·1 %, P = 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.