title: Tolerability of a probiotic in subjects with a history of methicillin-resistant Staphylococcus aureus colonisation.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of major public health importance. Colonisation precedes infection; thus reducing MRSA carriage may be of benefit for reducing infection. Probiotics represent a novel approach to reducing MRSA carriage. We undertook a pilot feasibility randomised controlled trial of the tolerability and acceptability of probiotics for reducing nasal and intestinal carriage of MRSA. In addition, subjects were screened for vancomycin-resistant enterocococci (VRE). Subjects with a history of MRSA were recruited from a large, academic medical center and randomised to take either a placebo or probiotic (Lactobacillus rhamnosus HN001). Subjects returned to the clinic after four weeks for further testing to determine adherence to the probiotic regimen and colonisation of MRSA. 48 subjects were enrolled and randomised. Nearly 25% were transplant recipients and 30% had diabetes. The probiotic was well tolerated in the study population though minor side effects, such as nausea and bloating, were observed. A majority of the subjects randomised to HN001 had good adherence to the regimen. At the four week time point among subjects randomised to the probiotic, MRSA was detected in 67 and 50% of subjects colonised in the nares and the gastrointestinal tract, respectively. Three subjects who initially tested positive for VRE were negative after four weeks of probiotic exposure. Probiotics were well tolerated in our study population of largely immunocompromised subjects with multiple comorbidities. Adherence to the intervention was good. Probiotics should be studied further for their potential to reduce colonisation by multidrug resistant bacteria.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Section of Infectious Diseases, 1685 Highland Avenue, Madison, WI 53792, USA.
authors.forename: S
authors.initials: S
authors.lastname: Warrack
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Section of Infectious Diseases, 1685 Highland Avenue, Madison, WI 53792, USA.
authors.forename: P
authors.initials: P
authors.lastname: Panjikar
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Section of Infectious Diseases, 1685 Highland Avenue, Madison, WI 53792, USA.
authors.forename: M
authors.initials: M
authors.lastname: Duster
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Section of Infectious Diseases, 1685 Highland Avenue, Madison, WI 53792, USA William S. Middleton Memorial Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA.
authors.forename: N
authors.initials: N
authors.lastname: Safdar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000382:microbiology*; D016983:Enterococcus / Q000302:isolation & purification; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology; D006801:Humans; D052201:Lacticaseibacillus rhamnosus / Q000254:growth & development*; D008297:Male; D055118:Medication Adherence; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D010342:Patient Acceptance of Health Care; D010919:Placebos / Q000008:administration & dosage; D019936:Probiotics / Q000008:administration & dosage* / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000382:microbiology*; D020713:Vancomycin Resistance; D055815:Young Adult
chemical_list: D010919:Placebos
keywords: HN001; Lactobacillus rhamnosus; MRSA; probiotics