Date of Completion of Thesis/SIP

Spring 4-23-2020

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

First Advisor

Carole Jenson

Second Advisor

Kimberly Langer

Abstract

Incidence of Clostridium difficile infection, (CDI) in patients receiving antibiotics is significant. In 2017, there were approximately 223,900 cases of CDI in hospitalized patients alone (Center for Disease Control [CDC], 2017). Despite enhanced infection control measures, CDI rates remain prevalent and are associated with increased costs to healthcare. An integrative literature review and synthesis was performed. Studies were analyzed to delineate if Lactobacillus containing probiotics, when administered concurrently with high risk antibiotics, decrease CDI rates for patients in the inpatient hospital setting. Additional analysis of probiotic safety and a cost versus benefit analysis was researched. The purpose of the review and analysis was to determine the strength of evidence for utilization of probiotics. Within this review, the use of probiotics to combat incidence of CDI was associated with low risk of adverse effects with probiotic use, and moderate effect on reducing CDI rates. Significant cost savings to inpatient facilities is also noted. The research findings suggest use of probiotics is associated with improved patient outcomes by decreasing incidence of CDI, reduced hospital length of stay, and the prevention of the physical and emotional consequences from CDI. A concept map was constructed to guide readers through the correlational relationship of a Lactobacillus probiotic on CDI rates, institutional cost savings, and adverse events. Despite promising findings in safety, cost reduction, and decreased incidence of CDI, due to high heterogenicity between studies, details regarding prescribing practices remain unclear. Therefore, precise recommendations for practice remain unknown and further research is warranted. These findings provide a foundation of knowledge that may be utilized by the advanced practice nurse and other healthcare providers. Monitoring for new research that emerges, or encouragement for further research to be performed, within the hospital setting, is needed. Until then, the data found within this review provides education related to the benefits of utilizing probiotics for patients receiving high risk antibiotics with a subsequent result of decreased incidence of CDI, decreased mortality related to CDI, and long-term cost savings to an institution. Robust clinical trials are needed to validate the effectiveness of particular dosages, duration, and species of probiotics. Therefore, institutional based prescribing guidelines cannot be formed at this time and prescribing should be left to the judgement of the prescribing provider.

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