Which probiotic has the best effect on preventing Clostridium difficile-associated diarrhea? A systematic review and network meta-analysis.
OBJECTIVE
Clostridium difficile-associated diarrhea (CDAD) accounts for up to 25% of patients with antibiotic-associated diarrhea (AAD). We aimed to determine which probiotic is most effective in preventing CDAD using a network meta-analysis.


METHODS
Studies were identified by searching PubMed, EMBASE and the Cochrane Library databases for randomized controlled trials (RCTs) that evaluated the efficacy of probiotic interventions for CDAD. Primary outcomes were the incidence rates of AAD and CDAD, and secondary outcomes were the duration of diarrhea and the time until onset of diarrhea. The PROSPERO registered number of this study is CRD42018106115.


RESULTS
Ten RCTs including 11 analyses and including 4 692 patients were identified. Compared with the control group, probiotic intervention reduced the incidence rates of CDAD (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.17-0.61) and AAD (OR 0.39, 95% CI 0.23-0.66). Similar results were observed regarding the duration of diarrhea and the time until onset of diarrhea. Meta-regression analysis showed a correlation between the type of probiotic used and the incidence of CDAD and AAD. All nine kinds of probiotic interventions were statistically more effective than the placebo, with Lactobacillus casei ranking as the best intervention (OR 0.19, 95% credible interval [CrI] 0.06-0.63) for decreasing the incidence rate of CDAD. L. casei also ranked the highest in reducing the incidence rate of AAD (OR 0.32, 95% CrI 0.14-0.74).


CONCLUSION
Lactobacilli strains, especially L. casei, have a good effect on the prevention of CDAD and AAD.
['Ma|Yan|Y|https://orcid.org/0000-0002-7507-8641', 'Yang|Jing Yu|JY|', 'Peng|Xia|X|', 'Xiao|Ke Yi|KY|', 'Xu|Qing|Q|', 'Wang|Chen|C|']
D000328:Adult D000368:Aged D000900:Anti-Bacterial Agents D002648:Child D016360:Clostridioides difficile D003015:Clostridium Infections D003967:Diarrhea D004761:Enterocolitis, Pseudomembranous D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D000071076:Network Meta-Analysis D016017:Odds Ratio D019936:Probiotics D016032:Randomized Controlled Trials as Topic D016896:Treatment Outcome
probiotics prevention network meta-analysis antibiotic-associated diarrhea Clostridium difficile