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A randomized controlled trial of Lactobacillus rhamnosus GG on antimicrobial-resistant organism colonization

Published online by Cambridge University Press:  06 April 2021

Adriana M. Rauseo ,
Tiffany Hink ,
Kimberly A. Reske ,
Sondra M. Seiler ,
Kerry M. Bommarito ,
Victoria J. Fraser ,
Carey-Ann D. Burnham ,
Erik R. Dubberke  and
for the CDC Prevention Epicenter Program
Adriana M. Rauseo
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
Tiffany Hink
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
Kimberly A. Reske
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
Sondra M. Seiler
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
Kerry M. Bommarito
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
Carey-Ann D. Burnham
Affiliation:
Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
Erik R. Dubberke*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
*
Author for correspondence: Erik Dubberke, E-mail: edubberk@wustl.edu
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Abstract

Objective:

Alteration of the colonic microbiota following antimicrobial exposure allows colonization by antimicrobial-resistant organisms (AROs). Ingestion of a probiotic, such as Lactobacillus rhamnosus GG (LGG), could prevent colonization or infection with AROs by promoting healthy colonic microbiota. The purpose of this trial was to determine the effect of LGG administration on ARO colonization in hospitalized patients receiving antibiotics.

Design:

Prospective, double-blinded, randomized controlled trial of LGG versus placebo among patients receiving broad-spectrum antibiotics.

Setting:

Tertiary care center.

Patients:

In total, 88 inpatients receiving broad-spectrum antibiotics were enrolled.

Intervention:

Patients were randomized to receive 1 capsule containing 1×1010 cells of LGG twice daily (n = 44) or placebo (n = 44), stratified by ward type. Stool or rectal-swab specimens were collected for culture at enrollment, during admission, and at discharge. Using selective media, specimens were cultured for Clostridioides difficile, vancomycin-resistant Enterococcus spp (VRE), and antibiotic-resistant gram-negative bacteria. The primary outcome was any ARO acquisition. Secondary outcomes included loss of any ARO if colonized at enrollment, and acquisition or loss of individual ARO.

Results:

ARO colonization prevalence at study enrollment was similar (LGG 39% vs placebo 39%). We detected no difference in any ARO acquisition (LGG 30% vs placebo 33%; OR,1.19; 95% CI, 0.38–3.75) nor for any individual ARO acquisition. There was no difference in the loss of any ARO (LGG 18% vs placebo 24%; OR, 1.44; 95% CI, 0.27–7.68) nor for any individual ARO.

Conclusion:

LGG administration neither prevented acquisition of ARO nor accelerated loss of ARO colonization.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 2 , February 2022 , pp. 167 - 173
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. Preliminary data from this study were presented in abstract (no. 2570) form at IDWeek 2019 on October 5, 2019, in Washington, DC.

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