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Which probiotic has the best effect on preventing Clostridium difficile ‐associated diarrhea? A systematic review and network meta‐analysis
Author(s) -
Ma Yan,
Yang Jing Yu,
Peng Xia,
Xiao Ke Yi,
Xu Qing,
Wang Chen
Publication year - 2020
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12839
Subject(s) - medicine , probiotic , lactobacillus casei , diarrhea , meta analysis , incidence (geometry) , odds ratio , placebo , randomized controlled trial , confidence interval , cochrane library , antibiotic associated diarrhea , clostridium difficile , antibiotics , microbiology and biotechnology , biology , food science , genetics , physics , alternative medicine , pathology , fermentation , bacteria , optics
Objective Clostridium difficile ‐associated diarrhea (CDAD) accounts for up to 25% of patients with antibiotic‐associated diarrhea (AAD). We aimed to determine which probiotic is most effective in preventing CDAD using a network meta‐analysis. Methods Studies were identified by searching PubMed, EMBASE and the Cochrane Library databases for randomized controlled trials (RCTs) that evaluated the efficacy of probiotic interventions for CDAD. Primary outcomes were the incidence rates of AAD and CDAD, and secondary outcomes were the duration of diarrhea and the time until onset of diarrhea. The PROSPERO registered number of this study is CRD42018106115. Results Ten RCTs including 11 analyses and including 4 692 patients were identified. Compared with the control group, probiotic intervention reduced the incidence rates of CDAD (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.17‐0.61) and AAD (OR 0.39, 95% CI 0.23‐0.66). Similar results were observed regarding the duration of diarrhea and the time until onset of diarrhea. Meta‐regression analysis showed a correlation between the type of probiotic used and the incidence of CDAD and AAD. All nine kinds of probiotic interventions were statistically more effective than the placebo, with Lactobacillus casei ranking as the best intervention (OR 0.19, 95% credible interval [CrI] 0.06‐0.63) for decreasing the incidence rate of CDAD. L. casei also ranked the highest in reducing the incidence rate of AAD (OR 0.32, 95% CrI 0.14‐0.74). Conclusion Lactobacilli strains, especially L. casei , have a good effect on the prevention of CDAD and AAD.