British Journal of Nutrition

Full Papers

Human and Clinical Nutrition

A Lactobacillus casei Shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries: a randomised controlled trial

Samford Wonga1a2a3 c1, Ali Jamousa1, Jean O'Driscolla4, Ravi Sekhara5, Mike Weldona5, Chi Y. Yaua6, Shashivadan P. Hirania2, George Grimblea3 and Alastair Forbesa3

a1 National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK

a2 School of Community and Health Science, City University, London EC1V 0HB, UK

a3 Centre for Gastroenterology and Clinical Nutrition, University College London, London WC1E 6BT, UK

a4 Department of Microbiology, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK

a5 Department of Gastroenterology, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK

a6 Medicine for Older People, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK

Abstract

Certain probiotics may prevent the development of antibiotic-associated diarrhoea (AAD) and Clostridium difficile-associated diarrhoea (CDAD), but their effectiveness depends on both strain and dose. There are few data on nutritional interventions to control AAD/CDAD in the spinal cord injury (SCI) population. The present study aimed to assess (1) the efficacy of consuming a commercially produced probiotic containing at least 6·5 × 109 live Lactobacillus casei Shirota (LcS) in reducing the incidence of AAD/CDAD, and (2) whether undernutrition and proton pump inhibitors (PPI) are risk factors for AAD/CDAD. A total of 164 SCI patients (50·1 (sd 17·8) years) with a requirement for antibiotics (median 21 d, range 5–366) were randomly allocated to receive LcS (n 76) or no probiotic (n 82). LcS was given once daily for the duration of the antibiotic course and continued for 7 days thereafter. Nutritional risk was assessed by the Spinal Nutrition Screening Tool. The LcS group had a significantly lower incidence of AAD (17·1 v. 54·9 %, P< 0·001). At baseline, 65 % of patients were at undernutrition risk. Undernutrition (64·1 v. 33·3 %, P< 0·01) and the use of PPI (38·4 v. 12·1 %, P= 0·022) were found to be associated with AAD. However, no significant difference was observed in nutrient intake between the groups. The multivariate logistic regression analysis identified poor appetite ( < 1/2 meals eaten) (OR 5·04, 95 % CI 1·28, 19·84) and no probiotic (OR 8·46, 95 % CI 3·22, 22·20) as the independent risk factors for AAD. The present study indicated that LcS could reduce the incidence of AAD in hospitalised SCI patients. A randomised, placebo-controlled study is needed to confirm this apparent therapeutic success in order to translate into improved clinical outcomes.

(Received April 23 2013)

(Revised August 05 2013)

(Accepted August 12 2013)

(Online publication September 18 2013)

Key Words:

  • Probiotics;
  • Spinal cord injuries;
  • Diarrhoea;
  • Undernutrition risk

Correspondence

c1 Corresponding author: S. Wong, fax +44 1296 315049, email samford.wong@ucl.ac.uk

Footnotes

  Abbreviations: AAD, antibiotic-associated diarrhoea; CDAD, Clostridium difficile-associated diarrhoea; CFU, colony-forming units; LcS, Lactobacillus casei Shirota; PPI, proton pump inhibitor; SCI, spinal cord injury; SNST, Spinal Nutrition Screening Tool

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