45th Interscience Conference on Antimicrobial Agents: Probiotics Cost-Effective in Preventing Antibiotic-Associated Diarrhea

In: Main

10 Apr 2010

Speaker: Henry S. Sacks, MD, PhD, Professor of Community Medicine, Medicine, and Biomathematics, Mount Sinai School of Medicine, New York, New York

In hospitalized patients who are starting antibiotic therapy, the simultaneous administration of probiotics such as live, nonpathogenic microorganisms (e.g., Lactobacillus or Sac-charomyces) may prevent antibiotic-associated diarrhea (AAD) and reduce costs, and it probably saves lives.

AAD occurs in up to one third of hospitalized patients. One of the most common types of AAD is caused by Clostridium difficile. The incidence of C. difficile infection has been increasing recently, and this illness can be fatal.
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Because of growing evidence that probiotics might prevent AAD, the investigators performed a computer simulation using estimates from the literature and decision analysis software to determine how much could be saved, in terms of costs and morbidity, by prescribing probiotics.

Base-case estimates and ranges included the probability of AAD when antibiotics were given; estimates were 20% (range, 5%-30%), whereas probiotics prevented AAD at a rate of 63% (48%-74%). In patients with AAD, hospital costs increased by $3,669 per patient, length of stay (LOS) increased by 3.6 days, the probability of relapse was 20% (range, 5%-45%), and the probability of death was 1°% (0.5%^4%).

By contrast, for a course of probiotics costing less than $50 per patient, the model yielded an average cost savings of $712 per patient and an average reduction in the LOS by 0.7 days. Patients most likely to benefit were older than 65 years of age and had been hospitalized for more than two weeks. Sensitivity analyses showed that probiotics also would save lives. canadian antibiotics

Colistin Re-introduced for Multidrug-Resistant, Gram-Negative Bacterial Infections

Speaker: Vincente Pintado, MD, Attending Physician, Department of Infectious Disease, Hospital Ramony Cajal, Madrid, Spain

Although abandoned in the 1980s because of reported renal toxicity, the polymyxin antibiotic colistin (Colymycin, Parke-Davis) appears to be effective for the treatment of severe infections caused by multidrug-resistant, gram-negative bacteria (MDR-GNB).

Because of the emergence of these bacteria in recent years, colistin has been re-introduced into clinical practice. A retro spective cohort study was conducted from 1995 to 2004 to assess the efficacy and toxicity of IV colistin in treating infections caused by MDR-GNB. During this period, 39 patients received colistin at a mean daily dose of 2.8 million International Units (IU) for a median period of 14 days (range, 3-46 days).

The main infections treated were pneumonia/tracheo-bronchitis in 27 patients, intra-abdominal infections in five patients, surgical-site infections in three patients, primary bacteremia in two patients, and urinary tract infections in two patients. Most patients were critically ill. The responsible pathogens were Acinetobacter species (67%), Pseudomonas aeruginosa (14%), Enterobacter species (14%), and other gram-negative bacteria (5%).

Clinical response, as measured by cure or improvement of the infection, was reported in 24 patients (67%), and the overall mortality rate in the group was 25% (9 of 36).

With respect to the concerns about toxicity, although 64% of this patient population received combination therapy with aminoglycosides along with colistin, only 14% of the patients experienced any deterioration of renal function, and all of these patients had previous renal failure. No cases of renal failure were seen in patients with normal baseline functions. No neurotoxicity was noted.

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