Youtube Summary of Probiotics

Here below, you will see my amateur bad attempt to try to make this topic a little more fun to digest.

Main point #1: clostridium difficile is a serious, bacterial problem in the U.S., that can cause death.

Just today (4/30/07) our professor was telling us how four people died in the hospital of this infection last year. Usually it’s treated with antibiotics, but sometimes they fail — at which point, the outlook is grim for the patient. There is good news though! Patients could be potentially treated with probiotics (although a funkier version of probiotics). With Dr. Aas, he’s reported much success with this form of treatment when patients can’t fight off C. difficile with metronidazole or vancomycin (these are the common antibiotic treatments).

Main Point #2: Von Niel argues that probiotics should be considered a mainstream therapy (see the Von Niel reference).

There are enough randomized controlled trials out there to support such a statement. But it is slow to catch on in the U.S., possibly because it usually takes 17 years for new scientific discoveries to get widely disseminated (Balas & Boren, 2000).  For safety information on which strains are safe and who can take probiotics:http://www.ajcn.org/cgi/content/abstr… The authors noted: “We found that probiotics are safe for use in otherwise healthy persons, but should be used with caution in some persons because of the risk of sepsis.” 

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Probiotics (from Von Neil, 2005)

We definitely know it works for:

Acute infectious diarrhea
Prevention of antibiotic-associated diarrhea Conditions that are potentially treatable by probiotics:Chronic diarrhea
Inflammatory bowel disease
Irritable bowel syndrome
Food allergyConditions that are potentially preventable:Traveler’s diarrhea
Necrotizing enterocolitis
Urogenital infections
Atopic disease
Dental cariesFuture applications proposed for:
Cystic fibrosis
Rheumatoid arthritis
Cancers

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What is clostridium difficile? (from JG Bartlett, 2006)

It’s a nasty bacteria.

Who gets it?

If you’ve taken antibiotics, are of advanced age, or in the hospital or recently came from the hospital.

What’s the significance of this problem?

A new epidemic strain of C. difficile has emerged that causes more frequent and more serious disease.

What are some symptoms?

“Clinical disease and C. difficile toxin are present almost exclusively in patients with recent antibiotic exposure, with rare exceptions.” So if you’ve taken antibiotics, that increases your risk. Clinical expression of infection almost always includes diarrhea, but symptoms vary widely.

Common findings in patients with infection: 1) colitis (inflammation of the colon) with cramps, 2) fever 3) abdominal pain 4) fecal leukocytes (white blood cells in the stool) 5) and inflammation on colonic biopsy (if you do a biopsy of the colon).

Pseudomembranous colitis (a type of infection of the colon) represents an advanced stage of disease, and although considered “nonspecific,” it is nearly diagnostic of C. difficile infection.  The disease is almost always restricted to the colon.

A recent report implicates gastric acid–suppressive agents as a risk for disease, but this has not been consistently observed.

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How come my microbiology professor doesn’t think probiotics work?

“Frequently, years or even decades are required for laboratory discoveries to reach clinical practice. It takes an estimated average of 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice” (Balas & Boren).

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Why the Healthcare System Should Care

Based upon their hospital’s rate of CDAD (clostridium difficile associated diarrhea) in 0.7% of discharges,they estimated that the total excess in US healthcare costs attributable to CDAD was likely >$1.1 billion.– from the Center for Disease Control.  Emerging Infectious Diseases • http://www.cdc.gov/eid • Vol. 12, No. 3, March 2006 

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References

Aas et al., 2003. Recurrent Clostridium difficile Colitis: Case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clinical Infectious Diseases 2003; 36: 580-5

Balas EA, Boren SA. Yearbook of Medical Informatics: Managing Clinical Knowledge for Health Care Improvement. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000

Bartlett, JG. Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med. 2006 Nov 21;145(10):758-64. Review.

Savino et al., (Randomized controlled trial talking about probiotics and cholic) Pediatrics 2007;119;e124-e130

Van Niel Pediatrics 2005; 115; 174-177

Weisman et al., (talking about randomized controlled trial looking at probiotics and infections in day care centers) Pediatrics 2005;115;5-9