Efficacy of Lactobacillus casei defensis in preventing Clostridum difficile infections

Background: Probiotics such as Lactobacillus casei defensis (LBCD) are discussed to prevent Clostridum difficile infections (CDI).

Methods: In a prospective case-control study of the medical departments of the Städtisches Krankenhaus Kiel, a prophylaxis with LBCD was offered to patients who were treated with antibiotics during their hospital stay. The CDI incidence during the intervention period from 01.04.2008 to 31.12.2008 was compared with the incidence during a previous period of the same months in 2007. Risk factors with a potential impact on CDI incidence were considered.

Results: The numbers of CDI were:

Department	Intervention period	Control period	p-value
I. Medical Dpt	35/2,760 (1,3%, 95%CI 0,9–1,8)	51/2,391 (2,1%, 95%CI 1,6–2,8)	0,011
II. Medical Dpt	29/2,546 1,1%, 95%CI 0,8–1,6)	48/2,453 (2,0%, 95%CI 1,4–2,6)	0,013
III. Medical Dpt	14/1,314 (1,1%, 95%CI 0,6–1,8)	28/1,261 (2,2%, 95%CI 1,5–3,2)	0,015

During the intervention period, the relative risk of CDI was 0,57 (95%CI 0,43–0,75) compared to the control period. However, when potential risk factors were analyzed, a slightly lower use of antibiotics and of proton pump inhibitors was observed during the intervention period. Age or comorbidity showed no differences.

Conclusions: During a period of organized administration of LBCD, a significant reduction of the incidence of CDI was observed. Although a potential impact of changing risk factors for CDI cannot be ruled out, these results may merit further investigation.