Effect of Lactobacillus rhamnosus HN001 on carriage of Staphylococcus aureus: results of the impact of probiotics for reducing infections in veterans (IMPROVE) study

Shoshannah Eggers, Anna K Barker, Susan Valentine, Timothy Hess, Megan Duster, Nasia Safdar, Shoshannah Eggers, Anna K Barker, Susan Valentine, Timothy Hess, Megan Duster, Nasia Safdar

Abstract

Background: Infection by Staphylococcus aureus (S. aureus) is a major cause of morbidity and mortality. Colonization by S. aureus increases the risk of infection. Little is known about decolonization strategies for S. aureus beyond antibiotics, however probiotics represent a promising alternative. A randomized controlled trial was conducted to determine the efficacy of Lactobacillus rhamnosus (L. rhamnosus) HN001 in reducing carriage of S. aureus at multiple body sites.

Methods: One hundred thirteen subjects, positive for S. aureus carriage, were recruited from the William S. Middleton Memorial Medical Center, Madison, WI, USA, and randomized by initial site of colonization, either gastrointestinal (GI) or extra-GI, to 4-weeks of oral L. rhamnosus HN001 probiotic, or placebo. Nasal, oropharyngeal, and axillary/groin swabs were obtained, and serial blood and fecal samples were collected. Differences in prevalence of S. aureus carriage at the end of the 4-weeks of treatment were assessed.

Results: The probiotic and placebo groups were similar in age, gender, and health history at baseline. S. aureus colonization within the stool samples of the extra-GI group was 15% lower in the probiotic than placebo group at the endpoint of the trial. Those in the probiotic group compared to the placebo group had 73% reduced odds (OR 0.27, 95% CI 0.07-0.98) of methicillin-susceptible S. aureus presence, and 83% reduced odds (OR 0.17, 95% CI 0.04-0.73) of any S. aureus presence in the stool sample at endpoint.

Conclusion: Use of daily oral L. rhamnosus HN001 reduced odds of carriage of S. aureus in the GI tract, however it did not eradicate S. aureus from other body sites.

Trial registration: ClinicalTrials.gov Identifier: NCT01321606 . Registered March 21, 2011.

Keywords: Clinical trial; Lactobacilli; MRSA; Probiotics; Veterans.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the University of Wisconsin-Madison Institutional Review Board (#2011–0063). All participants completed written informed consent prior to enrollment into the study.

Consent for publication

Not applicable.

Competing interests

SE’s spouse is employed by DuPont Nutrition and Health, who supplied the trial treatments, however this association had no influence on the conduct or outcome of this trial. All other authors have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Percent frequency of methicillin-resistant Staphylococcus aureus (MRSA), methicillin susceptible S. aureus (MSSA), and total combined S. aureus (SA) colonization at endpoint and baseline of the probiotic and placebo groups within the gastrointestinal (GI) (a) and extra-GI (b) strata. Results shown are from both polymerase chain reaction (PCR) assays, and culture assays. aStaphylococcus aureus Colonization at Baseline and Endpoint in GI Group. b Staphylococcus aureus Colonization at Baseline and Endpoint in Extra-GI Group
Fig. 2
Fig. 2
Cochran-Mantel-Haenszel odds ratios of methicillin-resistant Staphylococcus aureus (MRSA), methicillin susceptible S. aureus (MSSA), and total combined S. aureus (SA) colonization at different body sites, stratified by initial colonization site, either gastrointestinal (GI), or extra-GI, comparing the probiotic group to the placebo group

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