title: A Lactobacillus casei Shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries: a randomised controlled trial.
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 × 10⁹ 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.
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK.
authors.forename: Samford
authors.initials: S
authors.lastname: Wong
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Jamous
authors.affiliation: Department of Microbiology, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: O'Driscoll
authors.affiliation: Department of Gastroenterology, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK.
authors.forename: Ravi
authors.initials: R
authors.lastname: Sekhar
authors.affiliation: Department of Gastroenterology, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Weldon
authors.affiliation: Medicine for Older People, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK.
authors.forename: Chi Y
authors.initials: CY
authors.lastname: Yau
authors.affiliation: School of Community and Health Science, City University, London EC1V 0HB, UK.
authors.forename: Shashivadan P
authors.initials: SP
authors.lastname: Hirani
authors.affiliation: Centre for Gastroenterology and Clinical Nutrition, University College London, London WC1E 6BT, UK.
authors.forename: George
authors.initials: G
authors.lastname: Grimble
authors.affiliation: Centre for Gastroenterology and Clinical Nutrition, University College London, London WC1E 6BT, UK.
authors.forename: Alastair
authors.initials: A
authors.lastname: Forbes
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001066:Appetite; D016360:Clostridioides difficile; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004311:Double-Blind Method; D002149:Energy Intake; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007780:Lacticaseibacillus casei; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000150:complications*; D062407:Meals; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D019936:Probiotics / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors