Use of lactobacillus in prevention of recurrences of Clostridium difficile infection in solid organ transplant recipients

BACKGROUND: Clostridium difficile infection (CDI) can cause severe morbidity in transplant recipients; the effects of probiotic therapy in this population are unknown. METHODS: Single-center, retrospective chart review of lung and liver transplant recipients between January 2003 and December 2009 with positive C difficile enzyme immunoassay stool assays, some of whom received Lactobacillus preparations as adjunctive therapy per physician's choice. The association between Lactobacillus treatment and CDI recurrence was evaluated in unadjusted and adjusted logistic regression models. RESULTS: Lactobacillus was administered after 28 (55%) of 51 CDI episodes in the lung recipients and 34 (38%) of 89 CDI episodes in the liver recipients. Median duration of Lactobacillus therapy was 190 days for the lung recipients and 124 days for the liver recipients. Lactobacillus was associated with a 3-fold decreased risk for recurrence of CDI episodes overall (8/62 vs. 26/78; odds ratio [OR], 0.29; 95% confidence interval [CI], 0.1-0.8; P = 0.01) and 7-fold for the lung transplant recipients (2/28 vs. 12/23; OR, 0.03; 95% CI, 0.0-0.4; P = 0.0009) although not significant in the liver recipients alone (6/34 vs. 14/55; OR, 0.67; 95% CI, 0.2-2.25; P = 0.5). No patient developed invasive infection due to Lactobacillus. CONCLUSIONS: Lactobacillus seems to be safe in solid organ transplant recipients and may be associated with a decreased risk for recurrence of CDI episodes. These findings should be investigated in a larger prospective study.