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

  • Jeppe West Carstensen
  • Mahtab Chehri
  • Kristian Schønning
  • Steen Christian Rasmussen
  • Jacob Anhøj
  • Nina Skavlan Godtfredsen
  • Christian Østergaard Andersen
  • Andreas Munk PetersenEmail author
Original Article


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.



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

Compliance with ethical standards

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jeppe West Carstensen
    • 1
  • Mahtab Chehri
    • 1
    • 2
  • Kristian Schønning
    • 2
    • 3
  • Steen Christian Rasmussen
    • 2
  • Jacob Anhøj
    • 4
  • Nina Skavlan Godtfredsen
    • 3
    • 5
  • Christian Østergaard Andersen
    • 2
  • Andreas Munk Petersen
    • 1
    • 2
    • 3
    Email author
  1. 1.Gastro Unit, Medical DivisionCopenhagen University HospitalHvidovreDenmark
  2. 2.Department of Clinical MicrobiologyCopenhagen University HospitalHvidovreDenmark
  3. 3.Department of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
  4. 4.Centre of Diagnostic EvaluationRigshospitaletCopenhagenDenmark
  5. 5.Department of Pulmonary MedicineCopenhagen University HospitalHvidovreDenmark

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