Probiotics for prevention of Clostridium difficile infection.
Probiotics for prevention of Clostridium difficile infection.
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DOI：
10.1097/mog.0000000000000410
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发表时间：
2018-01
影响因子：
2.5
通讯作者：
Young VB
中科院分区：
文献类型：
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作者：
Mills JP;Rao K;Young VB
益生菌可以预防C.艰难梭菌感染（CDI），这是美国一种主要的医疗保健相关感染。然而，之前的研究受到产品和患者人群异质性的限制。最近的临床证据和益生菌开发的新方法进行了审查。益生菌的使用可以减少高风险人群中的CDI事件高达50%，尽管先前的临床试验产生了相互矛盾的结果。将益生菌与益生元结合可改善宿主的生长和植入。克劳氏芽孢杆菌和罗伊氏乳杆菌分泌直接抑制C.很难产生次级胆汁酸的微生物，如Clostridium glandens，增强C。难以定殖的抗性。非致病性C. difficile，提供营养生态位竞争，可以防止CDI。对粪便微生物群移植（FMT）的改进模糊了益生菌和FMT之间的界限。这些包括质量受控粪便产品（RBX 2660）、纯化厚壁菌门孢子（SER-109）和无菌粪便滤液。噬菌体可以治疗CDI，但在人类中的安全性和有效性尚不清楚。益生菌和我们对它们在预防CDI中的作用的理解已经取得了一些进展，但仍然存在一些重要的安全性和有效性问题。对天然微生物群结构和功能的更好理解将允许继续开发合理设计的益生菌疗法，以提供针对CDI的增强保护。
Probiotics may prevent C. difficile infection (CDI), a leading healthcare-associated infection in the United States. However, prior studies were limited by heterogeneity in products and patient populations. Recent clinical evidence and new approaches to probiotic development are reviewed. Probiotic use may reduce incident CDI in high risk populations by as much as 50%, though prior clinical trials have yielded conflicting results. Combining probiotics with prebiotics improves growth and engraftment in the host. Bacillus clausii and Lactobacillus reuteri secrete compounds that directly inhibit C. difficile. Organisms that produce secondary bile acids, such as Clostridium scindens, enhance C. difficile colonization resistance. Non-toxigenic C. difficile, which provides nutritional niche competition, may prevent CDI. Refinements to fecal microbiota transplantation (FMT) blur the line between probiotics and FMT. These include a quality-controlled stool product (RBX2660), purified Firmicutes spores (SER-109), and sterile fecal filtrate. Bacteriophages may treat CDI but have unknown safety and efficacy in humans. There have been a number of advances in probiotics and our understanding of their role in prevention of CDI, but a number of important safety and efficacy questions remain. An improved understanding of the native microbiota structure and function will allow for continued development of rationally designed probiotic therapy to provide enhanced protection against CDI.