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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2022; 12(02): 094-100
DOI: 10.1055/s-0043-1760738
Review Article

Systematic Review and Meta-Analysis: Safety and Efficacy of Saccharomyces boulardii for Prevention of Clostridioides difficile Infection

Raseen Tariq   *
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Muhammad Waqas Tahir   *
2   Department of Internal Medicine, Rochester General Hospital, Rochester, New York, United States
,
Maham Hayat
3   Division of Gastroenterology and Hepatology, University of Oklahoma, Oklahoma, United States
,
Darrell S. Pardi
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Sahil Khanna 
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
› Author Affiliations Funding None.
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Abstract

Background Clostridioides difficile infection (CDI) is associated with frequent recurrences. The role of probiotics in preventing CDI remains unclear despite patients frequently using them.

Methods We performed a systematic-review and meta-analysis to evaluate the role of Saccharomyces boulardii, a yeast probiotic, in preventing primary or recurrent CDI in patients on systemic antimicrobial therapy. We searched MEDLINE, Embase, and Web of Science up to December 2021 to identify studies (case-control, cohort, or clinical trial studies) reporting the use of systemic antimicrobials with or without S. boulardii and providing information on primary or recurrent CDI. Pooled odds ratios with 95% confidence intervals were calculated using a random effects model.

Results Eight studies (six randomized control trials and two cohort studies) were included. Six studies with 9,712 patients evaluated primary prevention. The rate of CDI in patients who received S. boulardii was 0.73% (44/5977) compared to 1.09% (41/3735) in the control group. Meta-analysis showed no difference in the risk of CDI among the two groups (odds ratio [OR], 0.71; 95%CI, 0.46–1.10; p = 0.124) with no significant heterogeneity (I2 = 0%). In two studies with 292 patients evaluating secondary prevention, the rate of recurrent CDI was 36.73% (54/147) on S. boulardii compared to 46.20% (67/145) in controls, with no significant difference (p = 0.19). Subgroup analysis of studies using S. boulardii (250 mg twice daily) showed no difference in the CDI risk with or without S. boulardii. No serious adverse events from S. boulardii were noted.

Conclusion The use of S. boulardii appears to have no benefit for preventing either primary or recurrent CDI in patients taking systemic antimicrobials.

Keywords

Clostridioides difficile - Saccharomyces boulardii - probiotics - prevention - antibiotic-associated diarrhea

Ethical Statement

This was a systematic review and meta-analysis with data available publicly, no patients were enrolled and hence ethical approval was not obtained.


Author Contributions

R.T.: concept, data interpretation, drafting and revision of manuscript; M.W.T.: data collection and interpretation, drafting and revision of the manuscript; M.H.: data collection and interpretation; D.S.P.: concept, data interpretation, drafting and revision of manuscript; S.K.: concept, data interpretation, drafting and revision of manuscript.


Data Availability Statement

This was a systematic review and meta-analysis with data available publicly, and no new data were generated.


* Co-first authors


Supplementary Material



Publication History

Received: 11 May 2022

Accepted: 14 July 2022

Article published online:
22 September 2023

© 2023. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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