In a retrospective cohort study, Freedberg et al1 analyzed the risk of hospitalized patients developing Clostridium difficile infection and found that the risk was higher if the previous occupant/patient of the hospital bed had received antibiotics. The putative mechanism is that a patient receiving antibiotics develops altered gut flora, leading to C difficile spores released into the environment and not eradicated by normal cleaning. The next patient using the bed is then exposed and infected.
We experience the exact same thing where I work but it is usually after the doctor in the ER has examined the patient and was not prescribed an antibiotic due to a viral infection. We find out after the clinic across the street calls us for the very same patient and test results. The common practice now is the combined use of probiotics when patients are placed on antibiotics (IV and PO). Studies confirm that some probiotics might be helpful in treating antibiotic-associated diarrhea (preventing C-diff). A recent study published in Gastroenterology found evidence that by dosing probiotics when antibiotics are started reduces the risk of Clostridium difficile infection (CDI) by more than 50% in hospitalized adult patients (Shen et al., 2017). However, there is further research needed to better understand which strains of bacteria are most helpful or what doses are required.
Most physicians typically advise patients against taking their antibiotics and probiotics at the exact time. Probiotics do not affect antibiotics, but antibiotics can make probiotics less effective. NIH suggests taking the probiotic 2 hours before or after the antibiotic to avoid any drug interaction.
Shen, N. T., Maw, A., Tmanova, L. L., Pino, A., Ancy, K., Crawford, C. V., … Evans, A. T. (2017). Timely use of probiotics in hospitalized adults prevents Clostridium difficile infection: A systematic review with meta-regression analysis. Gastroenterology, 152(8), 1889-1900.e9. doi:10.1053/j.gastro.2017.02.003
Improving our antibiotic use is critical to the safety of patients and the future of medicine. Ideally, antibiotic stewardship is a good idea. Now, it is also required by the Joint Commission and the Center for Medicare and Medicaid Services (CMS). Antibiotic stewardship should focus on improving appropriate use rather than simply reducing antibiotic use. The primary goal is universal, better patient care. Sometimes, better patient care involves using more antibiotics such as those meeting the core measure for sepsis. A patient with presumed sepsis should be started quickly on broad-spectrum antibiotics, an action that also falls under antibiotic stewardship. Teresa, you are so on the mark when you spoke to certain patient’s predisposition to c-diff but the severity of illness may necessitate the antibiotic therapy. Stewardship efforts are designed to be directed on optimizing appropriate use of antibiotic- promoting the use of the right agent at the correct dosage and for the proper duration-but as you said this is not the fix-all-solution