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Use of Lactobacillus in Prevention of Recurrences of Clostridium difficile Infection in Solid Organ Transplant Recipients

Deshpande, Abhishek MD, PhD*; Pasupuleti, Vinay MD, PhD; Mossad, Sherif B. MD; Budev, Marie DO, MPH§; Schmitt, Steven K. MD; Corey, Rebecca PharmD; Eghtesad, Bijan MD; Mawhorter, Steven D. MD; Hernandez, Adrian V. MD, PhD#; Jain, Anil MD**; Avery, Robin K. MD

Infectious Diseases in Clinical Practice: September 2013 - Volume 21 - Issue 5 - p 292–298
doi: 10.1097/IPC.0b013e31828d7231
Original Articles

Background Clostridium difficile infection (CDI) can cause severe morbidity in transplant recipients; the effects of probiotic therapy in this population are unknown.

Methods Single-center, retrospective chart review of lung and liver transplant recipients between January 2003 and December 2009 with positive C difficile enzyme immunoassay stool assays, some of whom received Lactobacillus preparations as adjunctive therapy per physician’s choice. The association between Lactobacillus treatment and CDI recurrence was evaluated in unadjusted and adjusted logistic regression models.

Results Lactobacillus was administered after 28 (55%) of 51 CDI episodes in the lung recipients and 34 (38%) of 89 CDI episodes in the liver recipients. Median duration of Lactobacillus therapy was 190 days for the lung recipients and 124 days for the liver recipients. Lactobacillus was associated with a 3-fold decreased risk for recurrence of CDI episodes overall (8/62 vs. 26/78; odds ratio [OR], 0.29; 95% confidence interval [CI], 0.1–0.8; P = 0.01) and 7-fold for the lung transplant recipients (2/28 vs. 12/23; OR, 0.03; 95% CI, 0.0–0.4; P = 0.0009) although not significant in the liver recipients alone (6/34 vs. 14/55; OR, 0.67; 95% CI, 0.2–2.25; P = 0.5). No patient developed invasive infection due to Lactobacillus.

Conclusions Lactobacillus seems to be safe in solid organ transplant recipients and may be associated with a decreased risk for recurrence of CDI episodes. These findings should be investigated in a larger prospective study.

From the *Department of Neurological Surgery, Neurological Institute; †Department of Molecular Cardiology, Lerner Research Institute; ‡Department of Infectious Diseases, Medicine Institute; §Department of Pulmonary and Critical Care Medicine, Respiratory Institute, The Cleveland Clinic, Cleveland, OH; ∥Department of Pharmacy, Mayo Clinic, Phoenix Campus, Phoenix, AZ; ¶Transplant Center, Digestive Diseases Institute; #Department of Quantitative Health Sciences, Lerner Research Institute; and **Department of Internal Medicine, Medicine Institute, The Cleveland Clinic, Cleveland, OH.

Correspondence to: Robin K. Avery, MD, FIDSA, Division of Infectious Diseases, Johns Hopkins Hospital, 1930 E Monument St, Room 434, Baltimore, MD 21287-0020. E-mail:

None of the authors have any financial or personal relationship with organizations that could potentially be perceived as influencing the described research.

Author contributions: Research design: AD, VP, AH, and RA; writing and revisions of the paper; AD, VP, RA, and all other authors; research: AD, VP, RC, AH, AJ, and RA; and data analysis: AH, AD, VP.

Abhishek Deshpande and Vinay Pasupuleti contributed equally to this work.

© 2013 by Lippincott Williams & Wilkins.