Probiotics for the Prevention and Treatment of Clostridium difficile in Older Patients

Jasmin Islam; Jonathan Cohen; Chakravarthi Rajkumar; Martin J. Llewelyn


Age Ageing. 2012;41(6):706-711. 

In This Article

Abstract and Introduction


Clostridium difficile infection (CDI) is the leading cause of nosocomial diarrhoea in older people, causing substantial morbidity and mortality. The fact that CDI is almost exclusively a disease of older people and the debilitated indicates that patient susceptibility is a major determinant of who gets CDI. It would help efforts to combat this disease if we better understood and could reduce patient susceptibility. In this regard, several strategies are currently under investigation. The use of probiotics for CDI has received particular attention in the medical and lay media. Patients and their carers often ask doctors about them. In this review article, we describe the pathogenesis of CDI before looking at the ageing host in more detail. We discuss how probiotics may work and review the current evidence for their use in CDI.


Huge efforts are being made to combat the spread of Clostridium difficile infection (CDI) in hospitals. Although rates have fallen markedly in the UK, it remains the leading healthcare-associated infection affecting older people.[1]

Clostridium difficile was described as a cause of antibiotic-associated diarrhoea (AAD) in 1978.[2] Rates of CDI increased through the 1990s, but the disease emerged dramatically after around 2000, when two major changes in epidemiology occurred. First, CDI rates rose exponentially throughout North America and Europe. In the UK, rates peaked in 2007 with over 50,000 cases reported, 80% being in patients aged over 65.[3] Second, the clinical syndrome associated with CDI changed. Initial reports of increased severity and mortality came from Quebec in Canada.[4] Novel strains of C. difficile ribotype 027 which were resistant to fluoroquinolone antibiotics became rapidly dispersed across North America and Europe and were linked to severe disease.[5] In the UK, ribotype 027 C. difficile was associated with notorious outbreaks at Stoke Mandeville and Maidstone Hospitals and came to account for over 40% of C. difficile isolates from English hospitals by 2007.[6,7] A huge effort across the NHS backed by the Department of Health has been made to reduce CDI rates. Key components include improved infection control practice, rapid diagnosis and isolation of cases, use of 'root-cause analysis' and antibiotic stewardship policies focused on reducing use of 'high-risk' antibiotics. Nevertheless, there were still over 20,000 cases of CDI in the NHS in 2010. While the prevalence of ribotype 027 strains is now falling in the UK, other virulent ribotypes are now being described.[8]