A combination of the probiotic and prebiotic product can prevent the germination of Clostridium difficile spores and infection

• Published in: Anaerobe Vol. 47; pp. 94 - 103
• Main Authors: Rätsep, M., Kõljalg, S., Sepp, E., Smidt, I., Truusalu, K., Songisepp, E., Stsepetova, J., Naaber, P., Mikelsaar, R.H., Mikelsaar, M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2017
• Subjects: Animals; Anti-Bacterial Agents - pharmacology; Antibiosis; Antibiotic susceptibility; Clostridium difficile; Clostridium difficile - drug effects; Clostridium difficile - isolation & purification; Clostridium difficile - physiology; Clostridium Infections - microbiology; Clostridium Infections - prevention & control; Disease Models, Animal; Estonia; Humans; Lactobacillus plantarum - drug effects; Lactobacillus plantarum - physiology; Lactobacillus plantarum inducia; Male; Mesocricetus; Microbial Sensitivity Tests; Norway; Prebiotics - administration & dosage; Prevention; Probiotics - administration & dosage; Spores; Spores, Bacterial - growth & development; Xylitol; Xylitol - administration & dosage; Prevention; Xylitol; Lactobacillus plantarum inducia; Antibiotic susceptibility; Spores; Clostridium difficile
• ISSN: 1075-9964; 1095-8274
• DOI: 10.1016/j.anaerobe.2017.03.019

Clostridium difficile infection (CDI) is one of the most prevalent healthcare associated infections in hospitals and nursing homes. Different approaches are used for prevention of CDI. Absence of intestinal lactobacilli and bifidobacteria has been associated with C. difficile colonization in hospitalized patients. Our aim was to test a) the susceptibility of C. difficile strains of different origin and the intestinal probiotic Lactobacillus plantarum Inducia (DSM 21379) to various antimicrobial preparations incl. metronidazole, vancomycin; b) the susceptibility of C. difficile strains to antagonistic effects of the probiotic L. plantarum Inducia, prebiotic xylitol (Xyl) and their combination as a synbiotic (Syn) product; c) the suppression of germination of C. difficile spores in vitro and in vivo in animal model of C. difficile infection with Inducia, Xyl and Syn treatment. The VPI strain 10463 (ATCC 43255), epidemic strain (M 13042) and clinical isolates (n = 12) of C. difficile from Norway and Estonia were susceptible and contrarily L. plantarum Inducia resistant to vancomycin, metronidazole and ciprofloxacin. The intact cells of Inducia, natural and neutralized cell free supernatant inhibited in vitro the growth of tested C. difficile reference strain VPI and Estonian and Norwegian clinical isolates of C. difficile after co-cultivation. This effect against C. difficile sustained in liquid media under ampicillin (0.75 μg/ml) and Xyl (5%) application. Further, incubation of Inducia in the media with 5% Xyl fully stopped germination of spores of C. difficile VPI strain after 48 h. In infection model the 48 hamsters were administered ampicillin (30 mg/kg) and 10–30 spores of C. difficile VPI strain. They also received five days before and after the challenge a pretreatment with a synbiotic (single daily dose of L. plantarum Inducia 1 ml of 1010 CFU/ml and 20% xylitol in 1 ml by orogastric gavage). The survival rate of hamsters was increased to 78% compared to 13% (p = 0.003) survival rate of hamsters who received no treatment. When administered Xyl the survival rate of hamsters reached 56% vs.13% (p = 0.06). In both Syn (6/9, p = 0.003) and Xyl (3/9, p = 0.042) groups the number of animals not colonized with C. difficile significantly increased. In conclusion, the combination of xylitol with L. plantarum Inducia suppresses the germination of spores and outgrowth into vegetative toxin producing cells of C. difficile and reduces the colonization of gut with the pathogen. Putative therapeutical approach includes usage of the synbiotic during antimicrobial therapy for prevention of CDI and its potential to reduce recurrences of CDI. •For prevention of C. difficile infection (CDI) a synbiotic product comprising Lactobacillus plantarum Inducia and prebiotic xylitol was applied.•The synbiotic composition suppressed growth of different C. difficile strains of Estonian and Norwegian origin in vitro.•The synbiotic composition fully stopped the germination of C. difficile VPI 10463 reference strain in vitro.•The prefeeding of synbiotic prevented the death of experimental hamsters and colonization of the gut with C. difficile.•The possibility to apply the synbiotic during antimicrobial treatment for prevention of CDI and its recurrencies is suggested.