Effect of probiotics on multi-resistant organism colonisation in persons with spinal cord injury: secondary outcome of ProSCIUTTU, a randomised placebo-controlled trial.

Toh, S-L; Lee, BB; Simpson, JM; Rice, SA; Kotsiou, G; Marial, O; Ryan, S

Effect of probiotics on multi-resistant organism colonisation in persons with spinal cord injury: secondary outcome of ProSCIUTTU, a randomised placebo-controlled trial.

Toh, S-L Lee, BB Simpson, JM Rice, SA Kotsiou, G Marial, O Ryan, S

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Publisher:: NATURE PUBLISHING GROUP
Publication Type:: Journal Article
Citation:: Spinal cord, 2020, 58, (7), pp. 755-767
Issue Date:: 2020-07

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Field	Value	Language
dc.contributor.author	Toh, S-L
dc.contributor.author	Lee, BB
dc.contributor.author	Simpson, JM
dc.contributor.author	Rice, SA
dc.contributor.author	Kotsiou, G
dc.contributor.author	Marial, O
dc.contributor.author	Ryan, S
dc.date.accessioned	2020-08-21T06:19:41Z
dc.date.available	2020-01-09
dc.date.available	2020-08-21T06:19:41Z
dc.date.issued	2020-07
dc.identifier.citation	Spinal cord, 2020, 58, (7), pp. 755-767
dc.identifier.issn	1362-4393
dc.identifier.issn	1476-5624
dc.identifier.uri	http://hdl.handle.net/10453/142287
dc.description.abstract	STUDY DESIGN:Randomised double-blind placebo-controlled trial. OBJECTIVES:Multi-resistant organism (MRO) colonisation is common in people with SCI. We aimed to determine whether Lactobacillus reuteri RC-14 + Lactobacillus GR-1 (RC14-GR1) and/or Lactobacillus rhamnosus GG + Bifidobacterium BB-12 (LGG-BB12) are effective in preventing or clearing MRO colonisation. SETTING:New South Wales, Australia. METHODS:The 207 SCI participants were randomised to one of four arms: (i) RC14-GR1 + LGG-BB12, (ii) RC14-GR1 + placebo, (iii) LGG-BB12 + placebo or (iv) double placebos for 6 months. Microbiological samples of nose, groin, urine and bowel were taken at baseline, 3 and 6 months. Analysis was conducted for the presence of methicillin-resistant Staphylococcus aureus (MRSA), multi-resistant gram-negative organisms (MRGNs) and vancomycin-resistant enterococcus (VRE). The outcomes were clearance of, or new colonisation with MRSA, MRGN, VRE or MROs and whether participants remained free of MRSA, MRGN, VRE or MROs throughout the study. Risk factors associated with an outcome were adjusted for using nominal or binary logistic regression. RESULTS:There was a significant reduction in new MRGN colonisation compared with placebo for participants treated with RC14-GR1 (OR 0.10, 95% CI, 0.01-0.88, P = 0.04), after allowing that inpatients were more likely to be newly colonised (OR 21.41, 95% CI, 3.98-115.13, P < 0.0001). Participants who intermittent self-catheterised (IMC) were more likely to remain MRO-free than those utilising SPC or IDCs (OR 2.80, 95% CI, 1.41-5.54, P = 0.009). CONCLUSIONS:Probiotics are ineffective at clearing MROs in people with SCI. However, RC14-GR1 is effective at preventing new colonisation with MRGNs. The use of IMC significantly improves the chance of remaining MRO-free.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	NATURE PUBLISHING GROUP
dc.relation.ispartof	Spinal cord
dc.relation.isbasedon	10.1038/s41393-020-0420-z
dc.rights	This is a post-peer-review, pre-copyedit version of an article published in [insert journal title]. The final authenticated version is available online at: https://www.nature.com/articles/s41393-020-0420-z]”
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences, 1106 Human Movement and Sports Sciences, 1109 Neurosciences
dc.subject.classification	Rehabilitation
dc.title	Effect of probiotics on multi-resistant organism colonisation in persons with spinal cord injury: secondary outcome of ProSCIUTTU, a randomised placebo-controlled trial.
dc.type	Journal Article
utslib.citation.volume	58
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1106 Human Movement and Sports Sciences
utslib.for	1109 Neurosciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Science
pubs.organisational-group	/University of Technology Sydney/Strength - ithree - Institute of Infection, Immunity and Innovation
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
dc.date.updated	2020-08-21T06:19:37Z
pubs.issue	7
pubs.publication-status	Published
pubs.volume	58
utslib.citation.issue	7

Abstract:

STUDY DESIGN:Randomised double-blind placebo-controlled trial. OBJECTIVES:Multi-resistant organism (MRO) colonisation is common in people with SCI. We aimed to determine whether Lactobacillus reuteri RC-14 + Lactobacillus GR-1 (RC14-GR1) and/or Lactobacillus rhamnosus GG + Bifidobacterium BB-12 (LGG-BB12) are effective in preventing or clearing MRO colonisation. SETTING:New South Wales, Australia. METHODS:The 207 SCI participants were randomised to one of four arms: (i) RC14-GR1 + LGG-BB12, (ii) RC14-GR1 + placebo, (iii) LGG-BB12 + placebo or (iv) double placebos for 6 months. Microbiological samples of nose, groin, urine and bowel were taken at baseline, 3 and 6 months. Analysis was conducted for the presence of methicillin-resistant Staphylococcus aureus (MRSA), multi-resistant gram-negative organisms (MRGNs) and vancomycin-resistant enterococcus (VRE). The outcomes were clearance of, or new colonisation with MRSA, MRGN, VRE or MROs and whether participants remained free of MRSA, MRGN, VRE or MROs throughout the study. Risk factors associated with an outcome were adjusted for using nominal or binary logistic regression. RESULTS:There was a significant reduction in new MRGN colonisation compared with placebo for participants treated with RC14-GR1 (OR 0.10, 95% CI, 0.01-0.88, P = 0.04), after allowing that inpatients were more likely to be newly colonised (OR 21.41, 95% CI, 3.98-115.13, P < 0.0001). Participants who intermittent self-catheterised (IMC) were more likely to remain MRO-free than those utilising SPC or IDCs (OR 2.80, 95% CI, 1.41-5.54, P = 0.009). CONCLUSIONS:Probiotics are ineffective at clearing MROs in people with SCI. However, RC14-GR1 is effective at preventing new colonisation with MRGNs. The use of IMC significantly improves the chance of remaining MRO-free.

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http://hdl.handle.net/10453/142287