Advertisement

Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants

  • Hanna Szajewska
    Affiliations
    Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland; the Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University School of Medicine, Cracow, Poland; Children’s Hospital, Kielce, Poland; and the Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
    Search for articles by this author
  • Maria Kotowska
    Affiliations
    Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland; the Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University School of Medicine, Cracow, Poland; Children’s Hospital, Kielce, Poland; and the Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
    Search for articles by this author
  • Jacek Z. Mrukowicz
    Affiliations
    Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland; the Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University School of Medicine, Cracow, Poland; Children’s Hospital, Kielce, Poland; and the Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
    Search for articles by this author
  • Malgorzata Arma′nska
    Affiliations
    Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland; the Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University School of Medicine, Cracow, Poland; Children’s Hospital, Kielce, Poland; and the Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
    Search for articles by this author
  • Wieslaw Mikolajczyk
    Affiliations
    Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland; the Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University School of Medicine, Cracow, Poland; Children’s Hospital, Kielce, Poland; and the Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
    Search for articles by this author

      Abstract

      Objective: Nosocomial diarrhea is a major problem in pediatric hospitals worldwide. We evaluated the efficacy of orally administered Lactobacillus GG (LGG) in the prevention of this disease in young children. Study design: Eighty-one children aged 1 to 36 months who were hospitalized for reasons other than diarrhea were enrolled in a double-blind trial and randomly assigned at admission to receive LGG (n = 45) at a dose of 6 × 109 colony-forming units or a comparable placebo (n = 36) twice daily orally for the duration of their hospital stay. Results: LGG reduced the risk of nosocomial diarrhea (≥3 loose or watery stools/24 h) in comparison with placebo (6.7% vs 33.3%; relative risk: 0.2; [95% CI: 0.06–0.6]; number needed to treat: 4 [95% CI: 2–10]). The prevalence of rotavirus infection was similar in LGG and placebo groups (20% vs 27.8%, respectively; relative risk: 0.72; 95% CI: 0.33–1.56). However, the use of LGG compared with placebo significantly reduced the risk of rotavirus gastroenteritis (1/45 [2.2%] vs 6/36 [16.7%], respectively; relative risk: 0.13; 95% CI: 0.02–0.79; number needed to treat: 7; 95% CI: 3–40). Conclusions: Prophylactic use of LGG significantly reduced the risk of nosocomial diarrhea in infants, particularly nosocomial rotavirus gastroenteritis. (J Pediatr 2001;138:361-5)

      Abbreviations:

      CFU (Colony-forming units), LGG (Lactobacillus GG), RR (Relative risk)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mrukowicz J
        • Krobicka B
        • Duplaga M
        • Kowalska-Duplaga K
        • Domanski J
        • Szajewska H
        • et al.
        Epidemiology and impact of rotavirus diarrhoea in Poland.
        Acta Paediatr Suppl. 1999; 426: 53-60
        • Matson DO
        • Estes MK
        Impact of rotavirus infection at a large pediatric hospital.
        J Infect Dis. 1990; 162: 598-604
        • Ford-Jones EL
        • Mindorff CM
        • Gold R
        • Petric M
        The incidence of viral-associated diarrhea after admission to a pediatric hospital.
        Am J Epidemiol. 1990; 131: 711-718
        • Ponce MF
        • Rial MJ
        • Alarcon N
        • Szefner M
        • Aguilar MD
        Use of a prospectively measured incidence rate of nosocomial diarrhea in an infant/toddler ward as a meaningful quality assessment tool.
        Clin Perform Qual Health Care. 1995; 3: 128-131
        • Craven D
        • Brick D
        • Morrisey A
        • O’Riordan MA
        • Petran V
        • Schreiber JR.
        Low yield of bacterial stool culture in children with nosocomial diarrhea.
        Pediatr Infect Dis J. 1998; 17: 1040-1044
        • Meropol SB
        • Luberti AA
        • De Jong AR
        Yield from stool testing of pediatric inpatients.
        Arch Pediatr Adolesc Med. 1997; 151: 142-145
        • Rohner P
        • Pittet D
        • Pepey B
        • Nije-Kinge T
        • Auckenthaler R
        Etiological agents of infectious diarrhea: implications for requests for microbial culture.
        J Clin Microbiol. 1997; 35: 1427-1432
        • Saavedra JM
        • Bauman NA
        • Oung I
        • Perman JA
        • Yolken RH.
        Feeding of Bifidobacterium bifidum and Streptococcus thermophilus to infants in hospital for prevention of diarrhoea and shedding of rotavirus.
        Lancet. 1994; 344: 1046-1049
        • Oberhelman RA
        • Gilman R
        • Sheen P
        • Taylor DN
        • Black RE
        • Cabrera L
        • et al.
        A placebo-controlled trial of Lactobacillus GG to prevent diarrhoea in undernourished Peruvian children.
        J Pediatr. 1999; 134: 15-20
        • Hilton E
        • Kolakowski P
        • Singer C
        • Smith M.
        Efficacy of Lactobacillus GG as a diarrhoeal preventive in travelers.
        J Travel Med. 1997; 1: 41-43
        • Oksanen PJ
        • Salminen S
        • Saxelin M
        • Hamalainen P
        • Ihantola-Vormisto A
        • Muurasniemi-Isoviita L
        • et al.
        Prevention of traveler’s diarrhoea by Lactobacillus GG.
        Ann Med. 1990; 22: 53-56
        • Vanderhoof JA
        • Whitney DB
        • Antonson DL
        • Hanner TL
        • Lupo JV
        • Young RJ.
        Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children.
        J Pediatr. 1999; 135: 564-568
        • Arvola T
        • Laiho K
        • Torkkeli S
        • Mykkanen
        • Salminen S
        • Maunula L
        • Isolauri E.
        Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: a randomized study.
        Pediatrics. 1999; 104: e64
        • Isolauri E
        • Juntunen M
        • Rautanen T
        • Sillanaukee P
        • Koivula T.
        A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children.
        Pediatrics. 1991; 88: 90-97
        • Isolauri E
        • Kaila M
        • Mykkanen H
        • Ling WH
        • Salminen S
        Oral bacteriotherapy for viral gastroenteritis.
        Dig Dis Sci. 1994; 39: 2595-2600
        • Kaila M
        • Isolauri E
        • Saxelin M
        • Arvilommi H
        • Vesikari T.
        Viable versus inactivated Lactobacillus strain GG in acute rotavirus diarrhoea.
        Arch Dis Child. 1995; 72: 51-53
        • Shornikova A-V
        • Isolauri E
        • Burnakova L
        • Lukovnikova S
        • Vesikari T.
        A trial in the Karelian Republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhoea.
        Acta Paediatr. 1997; 86: 460-465
        • Guarino A
        • Canani RB
        • Spagnuolo MI
        • Albano F
        • Di Benedetto L
        Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea.
        J Pediatr Gastroenterol Nutr. 1997; 25: 516-519
        • Guandalini S
        • Pensabene L
        • Abu Zikri M
        • Dias JA
        • Casali LG
        • Hoekstra H
        • et al.
        Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European study.
        J Pediatr Gastroenterol Nutr. 2000; 30: 54-60
        • Biller JA
        • Katz AJ
        • Flores AF
        • Buie TM
        • Gorbach SL.
        Treatment of recurrent Clostridium difficile colitis with Lactobacillus GG.
        J Pediatr Gastroenterol Nutr. 1995; 21: 224-226
        • Pochapin M.
        The effect of probiotics on Clostridium difficile diarrhea.
        Am J Gastroenterol. 2000; 95: S11-S13
        • Davidson GP
        • Daniels E
        • Nunan H
        • Moore AG
        • Whyte PBD
        • Franklin K
        • et al.
        Passive immunisation of children with bovine colostrum containing antibodies to human rotavirus.
        Lancet. 1989; 2: 709-712
        • Caul EO
        Small round structured viruses: airborne transmission and hospital control.
        Lancet. 1994; 343: 1240-1242
        • Ford-Jones EL
        • Mindorff CM
        • Gold R
        • Petric M
        The incidence of viral-associated diarrhea after admission to a pediatric hospital.
        Am J Epidemiol. 1990; 131: 711-718
        • Bennet R
        • Hedlund KO
        • Ehrnst A
        • Eriksson M
        Nosocomial gastroenteritis in two infant wards over 26 months.
        Acta Paediatr. 1995; 84: 667-670
        • Jamieson FB
        • Wang EE
        • Bain C
        • Good J
        • Duckmanton L
        • Petric M
        Human torovirus: a new nosocomial gastrointestinal pathogen.
        J Infect Dis. 1998; 178: 1263-1269
        • Goldin BR
        • Gorbach SL
        • Saxelin M
        • Barakat S
        • Gaultieri L
        • Salminen S.
        Survival of Lactobacillus species (strain GG) in human gastrointestinal tract.
        Dig Dis Sci. 1992; 37: 121-128
        • Silva M
        • Jacobus NV
        • Deneke C
        • Gorbach SL.
        Antimicrobial substance from a human Lactobacillus strain.
        Antimicrob Agents Chemother. 1987; 31: 1231-1233
        • Wilson KH
        • Perini I.
        Role of competition for nutrients in suppression of Clostridium difficile by the colonic microflora.
        Infect Immun. 1988; 56: 2610-2614
        • Bernet MF
        • Brassart D
        • Neeser JR
        • Servin AL.
        Lactobacillus acidophilus LA 1 binds to cultured human intestinal cell lines and inhibits cell attachment and cell invasion by enterovirulent bacteria.
        Gut. 1994; 35: 483-489
        • Davidson JN
        • Hirsch DC
        Bacterial competition as a means of preventing diarrhoea in pigs.
        Infect Immun. 1976; 13: 1773-1774
        • Rigothier MC
        • Maccanio J
        • Gayral P
        Inhibitory activity of Saccharomyces yeasts on the adhesion of Entamoeba histolytica trophozoites to human erythrocytes in vitro.
        Parasitol Res. 1994; 80: 10-15
        • Pothoulakis C
        • Kelly CP
        • Joshi MA
        • Gao N
        • O’Keane CJ
        • Castagliuolo I
        • et al.
        Saccharomyces boulardii inhibits Clostridium difficile toxin A binding and enterotoxicity in rat ileum.
        Gastroenterology. 1993; 104: 1108-1115
        • Czrucka D
        • Roux I
        • Rampal P.
        Saccharomyces boulardii inhibits secretagogue-mediated adenosine 3’,5’-cyclic monophosphate induction in intestinal cells.
        Gastroenterology. 1994; 106: 65-72
        • Kaila M
        • Isolauri E
        • Soppi E
        • Virtanen E
        • Laine S
        • Arvilommi H.
        Enhancement of the circulating antibody secreting cell response in human diarrhoea by a human Lactobacillus strain.
        Pediatr Res. 1992; 32: 141-144
        • Majamaa H
        • Isolauri E
        • Saxelin M
        • Vesikari T
        Lactic acid bacteria in the treatment of acute rotavirus gastroenteritis.
        J Pediatr Gastroenterol Nutr. 1995; 20: 333-339
        • Mack DR
        • Michail S
        • Wei S
        • McDougall L
        • Hollingsworth MA.
        Probiotics inhibit enteropathogenic E. coli adherence in vitro by inducing intestinal mucin gene expression.
        Am J Physiol. 1999; 276: G941-G950
        • Reuman PD
        • Duckworth DH
        • Smith KL
        • Bagan R
        • Buccarelli RL
        • Ayoub EM.
        Lack of effect of Lactobacillus GG on gastrointestinal bacterial colonisation in premature infants.
        Pediatr Infect Dis J. 1986; 5: 663-668
        • Millar MR
        • Bacon C
        • Smith SL
        • Hall MA.
        Enteral feeding of premature infants with Lactobacillus GG.
        Arch Dis Child. 1993; 69: 483-487