Bundling Probiotics With Antimicrobial Stewardship Programs for the Prevention of Clostridiodes difficile Infections in Acute Care Hospitals

Objective Several recommendations based on probiotics with a Clostridiodes difficile infection (CDI) prevention bundle were developed. Methods Using a modified Delphi process an expert panel of infectious disease specialists developed and voted on consensus statements regarding CDI. Results The panel voted on the following: (1) CDI prevention bundles with antimicrobial stewardship programs (ASPs) are more effective than single interventions in preventing CDI (11/11 panelists); (2) to implement a CDI prevention program that includes probiotics, an institution must have an ASP consistent with established guidelines (11/11); (3) it is important to measure adherence to all components of a CDI prevention bundle, with process and outcomes measures established (11/11): (4) sustainability of a successful probiotic intervention for CDI prevention can be enhanced by incorporating a probiotic order set in the electronic medical record (11/11); (5) champions should be identified and accountable for CDI prevention bundle implementation (11/11); (6) hospital administration support is necessary for a successful and sustained CDI prevention program (10/11); and (7) the probiotic product selected for a CDI prevention program should be a defined strain(s), with a specific formulation, timing, dose, duration, and potency at the time of consumption, with evidence-based efficacy for CDI prevention (11/11). Conclusions The panel members agreed with the statements developed and concluded that a bundle with specific probiotics with evidence-based efficacy should be appropriately incorporated into ASPs for the prevention of CDI. Care should be taken when planning the method of probiotic implementation and measures for monitoring adherence to protocol should be included.