Clostridium butyricum therapy for mild-moderate Clostridioides difficile infection and the impact of diabetes mellitus

Jen-Chieh Lee; Chun-Wei Chiu; Pei-Jane Tsai; Ching-Chi Lee; I-Hsiu Huang; Wen-Chien Ko; Yuan-Pin Hung

doi:10.12938/bmfh.2021-049

Clostridium butyricum therapy for mild-moderate Clostridioides difficile infection and the impact of diabetes mellitus

Biosci Microbiota Food Health. 2022;41(2):37-44. doi: 10.12938/bmfh.2021-049. Epub 2021 Nov 3.

Authors

Jen-Chieh Lee¹, Chun-Wei Chiu², Pei-Jane Tsai^{3

4

5}, Ching-Chi Lee^{1

6}, I-Hsiu Huang⁷, Wen-Chien Ko^{1

8}, Yuan-Pin Hung^{1

2}

Affiliations

¹ Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, North Dist., Tainan 704, Taiwan.
² Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, No. 125, Jhongshan Rd., West Central Dist., Tainan 70043, Taiwan.
³ Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Medical College, No.1, University Road, Tainan 701, Taiwan.
⁴ Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1, Dasyue Rd, East District, Tainan 701, Taiwan.
⁵ Center of Infectious Disease and Signaling Research, National Cheng Kung University, No.138, Sheng Li Road, North Dist., Tainan 704, Taiwan.
⁶ Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1, Dasyue Rd, East District, Tainan 701, Taiwan.
⁷ Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, 1111 W. 17th Street Tulsa, OK 74107, USA.
⁸ Department of Medicine, College of Medicine, National Cheng Kung University, 1 University Road, Tainan City 70101, Taiwan.

Abstract

The therapeutic effect of Clostridium butyricum for adults with Clostridioides difficile infection (CDI) was investigated. A retrospective study was conducted in medical wards of Tainan Hospital, Ministry of Health and Welfare, between January 2013 and April 2020. The disease severity of CDI was scored based on the Clinical Practice Guidelines of the IDSA/SHEA. Treatment success was defined as the resolution of diarrhea within six days of a therapeutic intervention without the need to modify the therapeutic regimen. In total, 241 patients developed CDI during hospitalization in the study period. The treatment success rates for the 99 patients with mild-moderate CDI among them were as follows: metronidazole, 69.4%; C. butyricum, 68.2%; metronidazole plus C. butyricum, 66.7%; and oral vancomycin, 66.7% (p=1.00). Patients with treatment success were less likely to have diabetes mellitus than those with treatment failure (38.2% vs. 61.3%, p=0.05). Patients treated with C. butyricum alone or in combination with metronidazole had shorter durations of diarrhea than those treated with metronidazole alone (3.1 ± 2.0 days or 3.5 ± 2.4 days vs. 4.2 ± 3.5 days; p=0.43 or 0.71), although the differences were not statistically significant. In conclusion, the treatment success rate of C. butyricum alone or in combination with metronidazole for patients with CDI was non inferior to that of metronidazole alone. The presence of diabetes mellitus in affected individuals is a risk factor for treatment failure.

Keywords: Clostridioides difficileinfection; Clostridium butyricum; diabetes mellitus; metronidazole; mild-moderate; probiotics.