Literature Review

The critical aspect of this research is to find evidence that would support the hypothesized claim that probiotics may treat diarrhea caused by Clostridium Difficile Infections. Therefore, the primary investigator (PI) used databases such as PubMed and Cumulative Index to Nursing and Allied Health to provide credible articles that would be useful in analyzing the aforementioned issue. During the search, the PI used keywords such as probiotic, hospitalized patients, diarrhea, health care, Clostridium difficile, antibiotic and dietitians. In the case of obtaining specific and relevant research articles, the primary investigator used the refine section of the database to limit the search to scholarly (peer reviewed) journals that were published in the past five years and full-text access to articles. The primary investigator selected the two articles because they provided relevant information on the use of probiotics to prevent Clostridium difficile. The articles provided level II evidence because of the randomized controlled trial. Moreover, one of the articles explains a cost-effective analysis regarding probiotics among hospitalized patients.

Summary and Appraisal of Evidence

The research entailed the use of decision-analytic modeling to perform a cost-effectiveness analysis. Regarding the level of evidence, it was a level II because of the well-designed randomized controlled study. The cost-effectiveness analysis entailed evaluating the cost incurred for receiving oral probiotics and the risk of Clostridium difficile-associated diarrhea (CDAD) versus a period of fewer than 30 days (Leal, Heitman, Conly, Henderson & Manns, 2016). The target group used was adult inpatients receiving antibiotics from a public hospital. The study involved administration of one dose of oral probiotic as a prevention intervention and continued for five days after completing the therapy. Regarding the alternative strategy, there was no probiotic administered to the target population. The estimates used came from the results of the study, local data, and literature. The results of the cost-effectiveness analysis indicated that a patient administered with oral probiotic resulted in direct costs of CDN $24 (Leal, Heitman, Conly, Henderson & Manns, 2016). The study concluded by indicating that on average, the cost of patients administered with oral probiotics was lower compared to usual care.

According to the study, probiotic reduced incidences of CDAD and AAD; however, the study exhibited heterogeneity regarding the secondary outcome, probiotics and study populations. Moreover, the study showed decreased precision because it involved small events and no research that addressed negative events due to CDAD. Another critical element that had insufficient information in the research included in Cochrane review concerned the duration of hospitalization of patients and costs incurred. When considering other estimates of the incremental cost, the results of the study did not vary. The limitations of this model included the following. First, the model provides an explanation for only one strategy that reduces Clostridium difficile-associated diarrhea. The model should have addressed other prevention and control strategies that would have helped to assess in conjunction with the use of probiotics. The second limitation is that the Cochrane review failed to provide a report that shows the effect of probiotics on severe CDAD. Third, since the evidence shows that CDAD varies depending on groups of patients, the study only involved adult inpatients from all hospital groups.

In the second article, a level II, randomized study involved elderly hospitalized patients. The target population was administered with oral antibiotics. The consumption per day was two 8-oz containers of probiotic. The one group consumed probiotics that contained yogurt while the other did not receive yogurt. The results of treating patients for eight days indicates that the frequency of diarrhea for subjects who consumed yogurt was less (12%) compared to subjects that did not consume yogurt (24%) (Rodavich, 2015). Similarly, regarding the total diarrhea days, patients who consumed yogurt reported a significantly less total number of days (23 days) compared to 60 days for those who did not consume yogurt. In the case of patients who report diarrhea, the recorded duration was 31% shorter on elements receiving yogurt compared to those who did not receive yogurt (Rodavich, 2015). Therefore, the results of the study indicate that the consumption of yogurt may help to prevent the frequency of antibiotic-associated diarrhea.

The report from subjects in the yogurt group shows that they did not experience any negative side effects from consuming yogurt. The study used a small dose of 8-oz of yogurt on a daily basis; therefore, this might have affected the results. Since it was a randomized assignment, the bias of the study was reduced. The study entailed elderly hospitalized patients who were divided into two groups; one that consumed yogurt and the other did not receive yogurt. The author concluded that the consumption of yogurt improves the diet quality thus helping consumers maintain metabolic well-being and intake of nutrients.

Summary and Synthesis of Findings

The two articles provided a detailed analysis and indirect answers to the claim that probiotics may treat diarrhea caused by Clostridium Difficile Infections. The first article indicated that the use of oral probiotics as a preventive intervention for Clostridium difficile-associated diarrhea reduced the risk of developing CDAD. Similarly, the strategy resulted in a reduced treatment cost of $518 per patient. In the second article, the two groups of elderly patients included those who consume yogurt and those who did not receive yogurt. The study concluded that consumption of yogurt might help to prevent the frequency of antibiotic-associated diarrhea. The primary investigator used the findings from both articles to answer the PICOT question. The findings helps to understand how probiotics compared to the absence of probiotics would reduce CDAD. The two articles provided a level II evidence. One of the studies indicated that the subjects did not experience any negative side effects from consuming yogurt (Rodavich, 2015). The evidence shows that the consumption of yogurt would decrease the frequency of diarrhea. In addition, administering probiotics reduce incidences of CDAD while minimizing the cost of treating patients. Therefore, as a nutritional professional, the findings would help in guiding at-risk individuals to use appropriate food rich in probiotic.

Applying the Evidence

Recommendations based on the appraisal included the following. First, there is need to implement the use of probiotics in treating CDAD in community hospitals and any other healthcare facility (Leal, Heitman, Conly, Henderson & Manns, 2016). Physicians, nurses, and other researchers should engage in developing detailed models and strategies that would provide an effective analysis of the use of probiotic. Second, health policy makers should campaign and prioritize funds for concomitant oral probiotics among patients that receive therapeutic antibiotics (Leal, Heitman, Conly, Henderson & Manns, 2016). The decision would help improve the treatment of CDAD and reduce the cost hospitalized patients would have paid for the services. Third, physicians and nurses should provide adequate probiotic activity and dosage to patients so that the results could show a positive effect of probiotics on antibiotic-associated diarrhea. Moreover, dietitians in a healthcare setting should guide patients, nurses, and physicians in choosing a high-quality probiotic supplement (Rodavich, 2015).

 Conclusion

When hospitalized patients receiving therapeutic antibiotics use one capsule of oral probiotic per day, they minimize the risk of CDAD. Similarly, administering oral probiotics to patients in a public healthcare system results in cost-savings of $518 per person. The benefits that patients would achieve include reduced length of stay, fewer complications and days on isolation. Additionally, patients should consume food and supplements rich in probiotics to reduce incidences and severity of CDAD.

References

Leal, J. R., Heitman, S. J., Conly, J. M., Henderson, E. A., & Manns, B. J. (2016). Cost-effectiveness analysis of the use of probiotics for the prevention of clostridium difficile–associated diarrhea in a provincial healthcare system. Infection Control & Hospital Epidemiology, 37(9), 1079-1086.

Rodavich, M. (2015). Probiotic may prevent and treat Clostridium difficile. Today’s Dietitian, 46-50.

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