ADS 27 - Gut Guardians: Harnessing Probiotic Drinks as a Shield Against C. Diff Invaders

Background: Patients with Clostridioides difficile infection (CDI) had the most significant death risk across all disease types during the Covid-19 pandemic. A hospital in N. Texas noticed a 30% spike in inpatient CDI above the Centers for Medicare & Medicaid Services (CMS) benchmarks in 2022. Persons receiving antibiotics are 7 to 10 times more likely to develop CDI. The American Gastroenterology Association recommends use of 6 probiotics strains to prevent CDI in patients on antibiotics. However, this practice has not been fully implemented or studied in a hospital setting.

Methods: The project was conducted as a prospective evidence-based quality improvement project on 11 units in a single hospital, from April—September 2023. The intervention was a commercially available probiotic drink with 5 probiotic strains. Nurses offered probiotic drinks twice daily to qualified patients, excluding patients on dialysis or with cancer. We tracked occurrence of CDI, patient tolerance and doses of the probiotic drink, length of stay, and number of antibiotics administered.

Results: We enrolled 683 patients in the pilot. Patients receiving probiotic drinks experienced no Hospital-acquired (HAI) CDI. We noted a 20% decrease in the total HAI CDI standardized infection ratio (SIR) in 2nd and 3rd quarters of 2023 compared to the same period in 2022. The pilot group experienced no CDI compared to concurrent hospital SIR of 0.574, Patients tolerated the probiotic drink with few complaints. Nurses documented a 3-bottle average of probiotic drinks per patient. Length of stays averaged 6 days with patients receiving an average of 2 types of antibiotics.

Conclusions: We find probiotic drinks effective at reducing CDI rates in hospitalized patients on antibiotics. Probiotic drinks are low cost, easy to implement, and well-tolerated. Based on positive results of this pilot, the team began extending use of probiotic drinks throughout the hospital in October 2023 while continuing to monitor CDI rates.