C. difficile感染症に対するプロバイオティクス：多施設研究

A Multicenter Evaluation of Probiotic Use for the Primary Prevention of Clostridioides difficile Infection, Clinical Infectious Diseases, 2021 

https://academic.oup.com/cid/article/73/8/1330/6273434

2019年5月にハイリスク患者に対して抗菌薬処方時に4病院で迅速に処方、前後比較経過中、前と比較しCD発生率は1.4倍に増加（効果は確認されず）

Background

Primary prevention of Clostridioides difficile infection (CDI) is a priority for hospitals. Probiotics have the potential to interfere with colonization and CDI. In this study, we evaluated the impact of a computerized clinical decision support (CCDS) tool to prescribe probiotics for primary prevention of CDI among adult hospitalized patients.

Methods

A CCDS tool was implemented into the electronic medical record at 4 hospitals to prompt prescription of a probiotic preparation at the time of antibiotic prescription in high-risk patients in May 2019. Interrupted time series using segmented regression analysis was conducted to evaluate hospital-wide CDI incidence for the year pre- and post-CCDS implementation. In addition, multivariable logistic regression was used to evaluate CDI incidence in patients who qualified for probiotics in the pre- vs post-intervention periods, adjusting for potential confounders. To adjust for potential differences in patients who received probiotics in the post-intervention period, propensity score-matched pairs were developed to evaluate CDI risk by receipt of probiotics.

Results

Quarterly CDI incidence increased over time post-intervention relative to baseline trends (slope change, 1.4; 95% confidence interval [CI], .9–1.9). The odds ratio (OR) of CDI was 1.41 in eligible patients post-intervention compared with pre-intervention (adjusted OR, 1.41; 95% CI, 1.11–1.79). Propensity score-matched analysis showed that patients who received probiotics did not have lower rates of CDI compared with those who did not receive probiotics (OR, 1.46; 95% CI, .87–2.45).

Conclusions

Use of probiotics for primary prevention of CDI among adult inpatients receiving antibiotics is not supported.