Probiotics are effective at preventing Clostridium difficile-associated diarrhea: a systematic review and meta-analysis.
Probiotics are effective at preventing Clostridium difficile-associated diarrhea: a systematic review and meta-analysis.
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DOI：
10.2147/ijgm.s98280
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发表时间：
2016
影响因子：
2.3
通讯作者：
Chamberlain RS
中科院分区：
文献类型：
--
作者：
Lau CS;Chamberlain RS
艰难梭菌感染（CDI）是腹泻相关性腹泻的主要原因。在过去十年中，CDI的发病率和严重程度有所增加，并且是一个日益严重的世界性健康问题，与大量的医疗保健费用和显著的发病率和死亡率相关。这项荟萃分析研究了益生菌对医院和门诊环境中儿童和成人艰难梭菌相关性腹泻（CDAD）发生率的影响。对所有已发表的随机对照试验（RCT）进行了全面的文献检索，这些试验评估了在接受抗生素治疗的患者中使用益生菌预防CDAD，并分析了CDAD的发生率。共分析了26项RCT，涉及7，957例患者。使用益生菌显著降低了60.5%发生CDAD的风险（相对风险[RR] =0.395; 95%置信区间[CI]，0.294-0.531; P<0.001）。益生菌在成人和儿童中均被证明是有益的（分别减少59.5%和65.9%），尤其是在住院患者中。乳酸菌、酵母菌和益生菌混合物都有利于降低CDAD的风险（分别降低63.7%、58.5%和58.2%）。益生菌补充剂与接受抗生素的患者发生CDAD的风险显著降低相关。需要进一步的研究来确定益生菌的最佳剂量和菌株。
Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea. CDI has increased in incidence and severity over the past decade, and is a growing worldwide health problem associated with substantial health care costs and significant morbidity and mortality. This meta-analysis examines the impact of probiotics on the incidence of Clostridium difficile-associated diarrhea (CDAD) among children and adults, in both hospital and outpatient settings. A comprehensive literature search of all published randomized control trials (RCTs) assessing the use of probiotics in the prevention of CDAD in patients receiving antibiotic therapy was conducted, and the incidence of CDAD was analyzed. Twenty-six RCTs involving 7,957 patients were analyzed. Probiotic use significantly reduced the risk of developing CDAD by 60.5% (relative risk [RR] =0.395; 95% confidence interval [CI], 0.294–0.531; P<0.001). Probiotics proved beneficial in both adults and children (59.5% and 65.9% reduction), especially among hospitalized patients. Lactobacillus, Saccharomyces, and a mixture of probiotics were all beneficial in reducing the risk of developing CDAD (63.7%, 58.5%, and 58.2% reduction). Probiotic supplementation is associated with a significant reduction in the risk of developing CDAD in patients receiving antibiotics. Additional studies are required to determine the optimal dose and strain of probiotic.