Use of Probiotics in the Prevention of Clostridioides difficile Infections during Antibiotic Exposure: A Systematic Review and Meta-Analysis

Clostridioides difficile infections are a growing concern in the hospital setting. Current prevention methods include infection control strategies, antibiotic stewardship, and proper hand hygiene. However, the occurrence of C. difficile still manages to cause nosocomial outbreaks especially in vulnerable populations. Probiotics have been historically questioned for their use in the prevention of antibiotic-associated diarrhea and more specifically, C. difficile infections. This meta-analysis pools 10 randomized controlled trials for the prevention of Clostridioides difficile infections (CDI) from reviewing the Cochrane Central Register of Controlled Trials (CENTRAL). A priori inclusion criteria remained as follows: RCTs, blinded/open trials, all populations, articles, or conference abstracts. Exclusion criteria excluded publications published outside 2013-2023*, non-English language trials, pre-clinical trials/protocols, case reports/series/systematic reviews, duplicates, probiotics not specified in methods, non-RCTs, incomplete/no outcomes reported, no confirmation of Clostridioides difficile infection. Probiotic strains tested in these trials mainly included Lactobacillus spp. and Bifidobacterium spp. Some studies showed significant benefits while others did not find significant improvement in the prevention of C. difficile infections. The meta-analysis suggests that probiotics may have a positive effect in preventing CDI during antibiotic treatment. The study results had large levels of statistical heterogeneity which indicates an argument for further large-scale research to provide more definitive evidence on the efficacy of probiotics in CDI prevention.