516. Implementation of a probiotic for the primary prevention of hospital-onset Clostridium difficile infection
Session: Poster Abstract Session: Healthcare Epidemiology: Updates in C. difficile
Thursday, October 4, 2018
Room: S Poster Hall
  • 516_IDWPOSTER final.pdf (508.2 kB)


    Hospital-onset Clostridium difficile infection (HO-CDI) affects over 100,000 patients in the U.S. each year. Due to a rising rate of HO-CDI at Denver Health, a multifaceted CDI prevention plan was implemented which included a probiotic intervention. The purpose of this study is to describe the implementation and uptake of the probiotic intervention.


    This is a retrospective study of adult inpatients who received antibiotics considered high-risk for the development of CDI from Mar 2017 – Mar 2018. In March 2017, a Best Practice Advisory (BPA) was implemented to advise providers to order Bio-K+ (L. acidophilus, L. casei, and L. rhamnosus) when they signed an order for a high-risk antibiotic. The BPA allowed providers to order or decline the probiotic directly from the BPA. The BPA was suppressed in patients who were pregnant, immunocompromised, unable to take oral medications, or had active CDI. The primary outcome was the proportion of patients for whom Bio-K+ was prescribed in the first year. Secondary outcomes include CDI rates before and after the intervention and adverse events defined as a positive Lactobacillus culture.


    The BPA fired in 3,840 cases, and Bio-K+ was ordered in 94.8% of these. For patients who received a high-risk antibiotic for at least 24 hours, there were 2,636 courses of Bio-K+ prescribed for 2,324 unique patients for a median duration of 3 days. The HO-CDI rates for one year pre and post intervention were 0.75 and 0.60 cases per 1000 patient days, respectively (p=0.16). Lactobacillus was cultured in 11 patients; 5 patients received Bio-K+ prior to culture. The positive cultures were from abdominal fluid (4) and sputum (1). There were no positive blood cultures in patients who received the probiotic.


    A probiotic intervention for the prevention of CDI implemented via BPA had excellent provider uptake. As part of a multifaceted CDI action plan, a probiotic intervention was well received and had a low risk of serious adverse events.

    Figure 1.


    Table 1.


    N=2,636 courses of Bio-K+

    Male, n (%)

    1,517 (58)

    Age, mean


    Length of stay, median days (IQR)

    5 (3-9)

    Days of Bio-K+, median (IQR)

    3 (2-6)

    Courses of high risk antibiotics















    Figure 2.

    Kati Shihadeh, PharmD1, Heather Young, MD2, Bryan Knepper, MPH, MS, CIC3, Robert Tapia, CPhT4 and Timothy C. Jenkins, MD4, (1)Acute Care Pharmacy, Denver Health Medical Center, Denver, CO, (2)Infectious Diseases, Denver Health Medical Center, Denver, CO, (3)Patient Safety and Quality, Denver Health Medical Center, Denver, CO, (4)Denver Health, Denver, CO


    K. Shihadeh, None

    H. Young, None

    B. Knepper, None

    R. Tapia, None

    T. C. Jenkins, None

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