ObjectiveTo systematically evaluate the efficacy of probiotics in preventing antibiotic-associated diarrhea (AAD) in aged people. MethodsPubMed, Web of Science, the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, CNKI, VIP, and WANFANG electronic databases were searched for studies published, and references of included studies and reviews were screened from database inception to April 2014. Only randomized, controlled trials involving patients older than 65 years were included. Furthermore, only the trials which combined antibiotic administration and probiotic therapy for the prevention of AAD and Jadad score >3 were extracted. ResultsA total of eight articles containing 3 680 subjects (1 843 in the probiotic group, 1 837 people in the control group) met the inclusion criteria. Meta-analysis showed that there was no significant difference in the risk of antibiotic-associated diarrhea (AAD) between probiotics and control groups[RR=0.76, 95%CI (0.51, 1.13), P=0.17]. Further subgroup analysis found that compared with the control group, saccharomyces[RR=1.24, 95%CI (0.70, 2.19), P=0.46], lactobacillus[RR=0.59, 95%CI (0.31, 1.13), P=0.11], multi-probiotics combination[RR=0.58, 95%CI (0.24, 1.41), P=0.23] in the probiotics group were not significantly different. ConclusionThere is no evidence to support that probiotics can reduce the risk of AAD among aged people administrated with antibiotics therapy.
Objective To investigate the infection rates of toxin-producing Clostridium difficile and Candida albicans in patients with antibiotic-associated diarrhea (AAD) in West China Hospital of Sichuan University, analyze their clinical characteristics and make a survey of the therapy. Methods Fecal specimens of AAD patients were collected in West China Hospital of Sichuan University from September 2014 to January 2015. Toxin-producing Clostridium difficile and Candida albicans were identified by polymerase chain reaction and then clinical data of cases was collected and analyzed. Results Twenty-eight patients with Clostridium difficile infection were detected from the 126 AAD patients, 20 patients (15.9%) in whom were infected with toxin-producing Clostridium difficile. Type A+B+, type A-B+, and type A+B- accounted for 35.7% (10/28), 35.7% (10/28) and 28.6% (8/28), respectively. Fifty-four patients (42.9%) with yeast infection were detected. The predominant isolate was Candida albicans, accounting for 20.6% (26/126), and the others were Candida glabrata (n=11), Candida tropical (n=10), Candida parapsilosis (n=3), Saccharomyces cerevisiae (n=2), Pichia pastoris (n=1), and Kodamaea ohmeri (n=1). Toxin-producing Clostridium difficile strains and Candida albicans strains were both isolated from 3 patients (2.4%). The main antibiotics used in AAD ppatients were penicillins, carbapenems, third generation cephalosporins, and fluoroquinolones. AAD patients were all with underlying diseases at different degrees. The main treatments were probiotics and montmorillonite powder. Conclusion The relatively high infection rates and complicated factors of AAD indicate that much more attention needs to be paid to the diagnosis and therapy of AAD by the clinical doctors.