title: Effectiveness of probiotic in preventing and treating antibiotic-associated diarrhoea and/or Clostridium difficile-associated diarrhoea in patients with spinal cord injury: a protocol of systematic review of randomised controlled trials.
abstract: BACKGROUND
  Probiotics may prevent antibiotic-associated and Clostridium difficile-associated diarrhoea (AAD/CDAD). Many spinal cord injury centre (SCIC) practitioners consider probiotics generically and may not realise that efficacy can be strain-, dose- and disease-specific. In order to confirm these effects and fully evaluate the extent of probiotic effectiveness in these patients, a systematic review and meta-analysis is indicated.
  
  
  METHODS
  The following databases will be searched for relevant studies: Cochrane Library; Centre for Reviews and Dissemination (CRD) Database; CINAHL; PsycINFO; Embase; Medline; AMED; International Clinical Trials Registry Platform Search Portal and ISRCTN Registry and will hand search a list of conference proceedings. Any randomised controlled trials without restriction of publication status will be included with treatment of AAD/CDAD. Outcomes will include the effect of probiotic on the occurrence of AAD/CDAD and duration of diarrhoea, intensive care unit admission, hospital mortality and length of hospital stay. Two reviewers will independently screen the titles, abstracts or even full texts and extract data. Two other reviewers will assess study quality. Revman 5.1 software will be used to conduct meta-analysis and calculate the risk ratio for dichotomous data. Weighted mean difference or standard mean difference will be calculated for continuous data. The Cochrane Collaboration's tool will be used to assess the risk of bias.
  
  
  CONCLUSIONS
  This systematic review protocol will provide information on probiotic therapy for AAD and CDAD in spinal cord injury (SCI) population. The results will be disseminated through peer-reviewed publication or conference presentation.
  
  
  BACKGROUND
  PROSPERO CRD42015016976.
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, HP21 8AL, UK. samford.wong@buckshealthcare.nhs.uk.|Centre for Health Services Research, City University, London, UK. samford.wong@buckshealthcare.nhs.uk.|Institute for Liver and Digestive Health, University College London, London, UK. samford.wong@buckshealthcare.nhs.uk.|Library Services, Stoke Mandeville Hospital, Aylesbury, UK. samford.wong@buckshealthcare.nhs.uk.
authors.forename: Samford
authors.initials: S
authors.lastname: Wong
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, HP21 8AL, UK. alijamous@btinternet.com.|Royal Buckinghamshire Hospital, Aylesbury, UK. alijamous@btinternet.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Jamous
authors.affiliation: Department of Microbiology, Stoke Mandeville Hospital, Aylesbury, UK. jean.odriscoll@buckshealthcare.nhs.uk.
authors.forename: Jean
authors.initials: J
authors.lastname: O'Driscoll
authors.affiliation: Department of Gastroenterology, Stoke Mandeville Hospital, Aylesbury, UK. ravi.sekhar@buckshealthcare.nhs.uk.
authors.forename: Ravi
authors.initials: R
authors.lastname: Sekhar
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, HP21 8AL, UK. modif.saif@buckshealthcare.nhs.uk.
authors.forename: Mofid
authors.initials: M
authors.lastname: Saif
authors.affiliation: Centre for Health Services Research, City University, London, UK. s.odriscoll@city.ac.uk.
authors.forename: Steve
authors.initials: S
authors.lastname: O'Driscoll
authors.affiliation: Library Services, Stoke Mandeville Hospital, Aylesbury, UK. sarah.lewis@buckshealthcare.nhs.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lewis
authors.affiliation: Centre for Health Services Research, City University, London, UK. Eamonn.McKeown.1@city.ac.uk.
authors.forename: Eamonn
authors.initials: E
authors.lastname: McKeown
authors.affiliation: Centre for Health Services Research, City University, London, UK. Shashi.hirani.1@city.ac.uk.
authors.forename: Shashi P
authors.initials: SP
authors.lastname: Hirani
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000254:growth & development*; D003967:Diarrhea / Q000139:chemically induced / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D007239:Infections / Q000188:drug therapy; D017063:Outcome Assessment, Health Care; D019936:Probiotics / Q000627:therapeutic use*; D012107:Research Design; D013119:Spinal Cord Injuries / Q000150:complications; D000078202:Systematic Reviews as Topic; D015201:Meta-Analysis as Topic
chemical_list: D000900:Anti-Bacterial Agents