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Use of prophylactic Saccharomyces boulardii to prevent Clostridium difficile infection in hospitalized patients: a controlled prospective intervention study

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Abstract

Clostridium difficile infection (CDI) is a common complication to antibiotic use. Saccharomyces boulardii has shown effect as a prophylactic agent. We aimed to evaluate the efficacy of S. boulardii in preventing CDI in unselected hospitalized patients treated with antibiotics. We conducted a 1 year controlled prospective intervention study aiming to prescribe Sacchaflor (S. boulardii 5 × 109, Pharmaforce ApS) twice daily to hospitalized patients treated with antibiotics. Comparable departments from three other hospitals in our region were included as controls. All occurrences of CDI in patients receiving antibiotics were reported and compared to a baseline period defined as 2 years prior to intervention. Results were analyzed using run chart tests for non-random variation in CDI rates. In addition, odds ratios for CDI were calculated. S. boulardii compliance reached 44% at the intervention hospital, and 1389 patients were treated with Sacchaflor. Monthly CDI rates dropped from a median of 3.6% in the baseline period to 1.5% in the intervention period. S. boulardii treatment was associated with a reduced risk of CDI at the intervention hospital: OR = 0.06 (95% CI 0.02–0.16). At two control hospitals, CDI rates did not change. At one control hospital, the median CDI rate dropped from 3.5 to 2.4%, possibly reflecting the effects of simultaneous multifaceted intervention against CDI at that hospital. The results from this controlled prospective interventional study indicate that S. boulardii is effective for the prevention of CDI in an unselected cohort of mainly elderly patients from departments of internal medicine.

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Funding

The study is financed by internal funding at Copenhagen University Hospital Hvidovre, Denmark.

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Authors and Affiliations

  1. Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark

    Jeppe West Carstensen, Mahtab Chehri & Andreas Munk Petersen

  2. Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark

    Mahtab Chehri, Kristian Schønning, Steen Christian Rasmussen, Christian Østergaard Andersen & Andreas Munk Petersen

  3. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Kristian Schønning, Nina Skavlan Godtfredsen & Andreas Munk Petersen

  4. Centre of Diagnostic Evaluation, Rigshospitalet, Copenhagen, Denmark

    Jacob Anhøj

  5. Department of Pulmonary Medicine, Copenhagen University Hospital, Hvidovre, Denmark

    Nina Skavlan Godtfredsen

Authors
  1. Jeppe West Carstensen
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  2. Mahtab Chehri
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  3. Kristian Schønning
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  4. Steen Christian Rasmussen
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  5. Jacob Anhøj
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  6. Nina Skavlan Godtfredsen
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  7. Christian Østergaard Andersen
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  8. Andreas Munk Petersen
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Corresponding author

Correspondence to Andreas Munk Petersen.

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Conflict of interest

All authors declare no conflict of interest.

Ethical approval

The study was a non-randomized intervention study in departments with high frequency of CDI and approved by the hospital director and the hospital administration.

Informed consent

Informed consent by patients was given according to standard treatment procedure and according to Danish law.

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Carstensen, J.W., Chehri, M., Schønning, K. et al. Use of prophylactic Saccharomyces boulardii to prevent Clostridium difficile infection in hospitalized patients: a controlled prospective intervention study. Eur J Clin Microbiol Infect Dis 37, 1431–1439 (2018). https://doi.org/10.1007/s10096-018-3267-x

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  • DOI: https://doi.org/10.1007/s10096-018-3267-x

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