971. Hospital-wide Evaluation of Probiotic Administration as Primary Prevention of Clostridium difficile infection (CDI) in a Tertiary Care Hospital
Session: Poster Abstract Session: Clostridium difficile Infections: Treatment and Prevention
Friday, October 9, 2015
Room: Poster Hall
  • IDWeek_2015_probiotics_version 2.1.pdf (361.4 kB)
  • Background: In randomized controlled trials and meta-analyses, as primary prevention, probiotics reduced C. difficile infection (CDI) among hospital patients. We performed a before-after evaluation of a Lactobacillus casei, L. acidophilus, and L. rhamnosus (BioK+) probiotic.

    Methods: We administered probiotic to antibiotic recipients in a 694-bed teaching hospital. After we excluded pediatric, neonatal, and oncology units there were 575 eligible beds. We evaluated 12 month baseline (Oct. 1, 2012-Sep. 30, 2013) and intervention (Nov. 1, 2013-Oct. 31, 2014) periods; October 2013 was a 1-month run-in. Our protocol was to administer probiotic < 12 hours after initial antibiotic receipt, to continue daily for five days post final dose. We excluded patients on preoperative antibiotics or npo, or with pancreatitis, leukopenia, or post-transplant. Over several years pre-baseline, the hospital began PCR testing, antibiotic controls, enhanced cleaning, and hand hygiene campaigns; no interventions were added during the project. CDI was determined by a recommended infection surveillance definition. We compared baseline and intervention periods by segmented regression models.

    Results: There were 283 CDI episodes among 360,016 patient days during the baseline and intervention periods, incidence = 7.9 per 10,000 patient-days. The incidence was similar during baseline and intervention periods (7.7 vs 8.0 per 10,000 patient-days; P=0.70). By segmented regression analysis, compared to the level baseline slope, there was a significant decrease in CDI during the intervention, P=0.05, Figure. The incidence rate ratio (IRR) in the final 6 months of intervention was 24% lower than baseline: IRR=0.76; 95% CI (0.54 to 1.1). Compared to the first 6 months of the intervention, the CDI rate in the final 6 months decreased 43%: IRR=0.57; 95% CI (0.40 to 0.80). Testing intensity was stable in baseline vs intervention periods, 19% vs 20% of stools tested were C. difficile PCR positive.

    Conclusion: Probiotic administration targeted to antibiotic recipients was associated with a trend toward a reduced CDI incidence. The decline was evident 6 months post-implementation, possibly reflecting delayed impact due to combination of antibiotic and environmental risk factors.

    William Trick, MD1, Stephen Sokalski, DO2, Joseph Levato, Pharm D2, Rolla Sweis, Pharm D2, Surej Veleeparambil, MBBS2, Stuart Johnson, MD, FIDSA3,4, Robert a. Weinstein, MD, FIDSA, FSHEA1 and CDC Prevention Epicenter Program, (1)Cook County Health & Hospitals System, Chicago, IL, (2)Advocate Christ Medical Center, Oak Lawn, IL, (3)Loyola University Chicago Stritch School of Medicine, Maywood, IL, (4)Edward Hines Jr. Veterans Affair Hospital, Maywood, IL


    W. Trick, None

    S. Sokalski, BioK+: Investigator , Research support

    J. Levato, None

    R. Sweis, None

    S. Veleeparambil, None

    S. Johnson, BioK+: Scientific Advisor , Consulting fee

    R. A. Weinstein, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.