The mechanisms and safety of probiotics against toxigenic clostridium difficile

ABSTRACT

Introduction

Toxigenic Clostridium difficile (C. difficile) is the main cause of antibiotic-associated diarrhea and can induce pseudomembranous colitis and infrequent toxic megacolon, which are potentially fatal. The standard antibiotic therapy for C. difficile infection (CDI) is limited by antibiotics’ broad spectrum and further disruptive effects on indigenous microbiota. Probiotics may offer a prospective and alternative strategy for the prevention and treatment of CDI.

Areas covered

In this article, the mechanisms implying the probiotic effect against C. difficile and the safety profile highlighting the patient groups with inappropriate application of probiotics were reviewed from 2015 to 2020.

Expert opinion

Although many strains with ability against C. difficile have been reported, the usage of probiotics for CDI prevention and/or treatment is scarce since the number of clinical trials is not sufficient to prove probiotics’ efficacy and safety in CDI treatment, especially for premature infant and immunocompromised patient. Especially, there are few well-defined clinical studies supporting safety of probiotics for CDI. A few strains from Lactobacillus and Saccharomyces genus have been studied more extensively than other probiotic strains through clinical trials for CDI. Thus, more clinical intervention studies regarding the benefit and the comprehensive safety assessments of probiotics for CDI are needed.

KEYWORDS:

• Probiotics
• toxigenic Clostridium difficile
• safety
• clinical trial
• lactobacillus
• saccharomyces
• bifidobacterium

Article highlights

• The majority of probiotic strains reported with potential protective effect against C. difficile were from Saccharomyces, Bifidobacterium, or Lactobacillus genera.

• The mechanisms revealing the beneficial effects of probiotics on CDI vary among different probiotic strains, which need to be further studied.

• Although probiotics are generally safe, bacteremia and fungemia have been reported in immunocompromised and critically ill patients.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed being on the scientific board of Bio-K+. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was funded by the National Natural Science Foundation of China (Grant No. 81970730), the Scientific Research Foundation of Xuzhou Medical University (2015KJ06), the Program for Youth Science and Technology Innovative Research Team of Xuzhou Medical University, the Scientific Research Foundation for the Talents of Xuzhou Medical University (D2012014), Top-notch Academic Programs Project of Jiangsu Higher Education Institutions (TAPP) (PPZY2015B161), a Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), National Demonstration Center for Experimental Basic Medical Science Education (Xuzhou Medical University) and was sponsored by the 333 Project of Jiangsu Province, China. The funders had no role in the study design, data collection or interpretation, or the decision to submit the work for publication.