Inhibition of Quinolone- and Multi-Drug-Resistant Clostridioides Difficile Strains by Multi Strain Synbiotics-An Option for Diarrhea Management in Nursing Facilities

Henning Sommermeyer, Hanna M Pituch, Dorota Wultanska, Paulina Wojtyla-Buciora, Jacek Piatek, Malgorzata Bernatek, Henning Sommermeyer, Hanna M Pituch, Dorota Wultanska, Paulina Wojtyla-Buciora, Jacek Piatek, Malgorzata Bernatek

Abstract

Diarrhea is a common problem in nursing homes. A survey among nursing facilities in Poland was used to characterize diarrhea outbreaks, the burden caused for residents and caregivers and the employed measures. Survey results confirmed that diarrhea is a common problem in nursing homes and in most cases affects groups of residents. The related burden is high or very high for 27% of residents and 40% of caregivers. In 80% of nursing facilities pro or synbiotics are part of the measures used to manage diarrhea. Administration of these kinds of products has been suggested for the management of diarrhea, especially in cases caused by Clostridioides (C.) difficile. C. difficile is one of many potential causes for diarrhea, but is of particular concern for nursing homes because it is responsible for a large proportion of diarrhea outbreaks and is often caused by multi-drug resistant strains. In vitro inhibition of a quinolone-resistant and a multi-drug resistant C. difficile strain was used to evaluate the growth inhibitory effects of commonly used products containing probiotic microorganisms. Growth of both strains was best inhibited by multi-strain synbiotic preparations. These findings suggest that multi-strain synbiotics can be considered as an interventional option for diarrhea caused by C. difficile.

Keywords: Clostridioides difficile; antibiotics; gut microbiota; multi-drug resistance; nursing facility; pathogen inhibition; prebiotics; probiotics; ribotype 027; synbiotics.

Conflict of interest statement

Henning Sommermeyer works as a consultant for Vivatrex GmbH, a company which markets products containing probiotic microorganisms in Germany. Vivatrex GmbH was not involved in the design, collection, analyses or interpretation of data, in writing the manuscript, or in the decision to publish the results. All other authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Average percentage of residents, indicated by column height, who had diarrhea at least once a year as function of nursing home size and average age of residents (total number of answers n = 55). Values were only calculated in cases where at least three answers were available for the respective size/age-category (n.d. = insufficient number of data).
Figure 2
Figure 2
Average number of patients affected by an individual diarrhea outbreak (total number of answers n = 59).
Figure 3
Figure 3
Burden related to diarrhea for nursing home residents and care givers as estimated by the nursing home management (total number of answers for burden for residents of n = 59 and for burden for care givers n = 59).
Figure 4
Figure 4
Interventions employed for the management of diarrhea cases in nursing facilities (total number of answers n = 59).
Figure 5
Figure 5
In vitro growth inhibition of C. difficile strains by different probiotics and two multi strain synbiotics. The L. rhamnosus E/N, Oxy, Pen mixture contains the three different probiotics in a CFU ratio of 40%/20%/40%. Detailed information about the composition of the multi strain synbiotics (containing 9 different bacterial probiotic and FOS) are provided under Materials and Methods.

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