Effect and Tolerability of Lactobacillus Rhamnosus GG LA801 for the Preventive Nutritional Care of Nosocomial Diarrhea in Children

Diarrhea in children According to the World Health Organization, diarrhea is defined by the release of at least three loose or watery stools per day or with an abnormal frequency for a single individual. It is generally a symptom of gastrointestinal infection who might be of bacterial or viral, parasite origin. Acute diarrhea is a frequent pathology, with an infectious origin in most of the cases, especially viruses and bacteria in industrialized countries. It leads to a risk of acute dehydration, in particular in high-risk populations as newborns, infants and toddlers.

Acute diarrhea is still the second leading cause of infection-associated death of children under five worldwide and in 2011 it was estimated to account for almost 10 % of the 7 million deaths in that population. In European countries, most cases show only mild or moderate symptoms and fatal outcomes are very uncommon. However gastroenteritis is still one of the main reasons for hospitalization of children in this region. In Europe, the incidence or diarrhea ranges from 0.5 to 2 episodes per year in children under 3 years old. Dehydration secondary to an acute diarrhea is still one of the main cause of death in young children that could be prevented in industrialized countries. Acute diarrhea is mostly associated with acute gastroenteritis, which is one of the main reason for hospitalization of children under 3 but it is also associated with antibiotics therapy (Antibiotics Associated Diarrhea or AAD) or hospital-acquired infections.

Hospital-acquired or nosocomial diarrhea (ND) Infections occurring more than 48 hours after hospital admission are usually considered as nosocomial infections. The incidence of this kind of infections among children in the industrialized countries remains very high, ranging from 5.1% to 11.6% depending on the time of the year and the type of hospital. In children, gastrointestinal infections account for the majority of the hospital-acquired infections and rotavirus is the main pathogenic agent. Those infections can lead to nosocomial diarrhea and therefore have numerous health and economic consequences as they tend to prolong hospital stay and mortality. Moreover nosocomial infections are usually treated with broad spectrum antibiotics without knowing the type of bacteria responsible for the infection or its antibiogram. This results in the selection of resistant microorganisms leading to increased antimicrobial resistance. All these factors combine for an increase of the financial burden of the healthcare system due to nosocomial infections. Nosocomial infections are more prevalent in the pediatric population than in the adult population and predominantly occur in intensive care units (ICU). In settings other than the ICU, the most common pediatric nosocomial infection is gastroenteritis. Rotavirus and norovirus account for the vast majority of the hospital-acquired gastroenteritis. Although, regular precautions such as hand hygiene or isolation of sick patients can prevent the spread of the infections, there is a clear need for new prevention strategies, and among those the use of probiotics is a promising one.

Probiotics and nosocomial diarrhea It is important to consider that no broad consensus exists to recommend the use of probiotics in the prevention of diarrhea, mainly because of the different design of the studies done so far. Therefore, there is a need for more well-designed studies before recommendations can be proposed.

However, three systematic reviews have assessed the efficacy of probiotics supplementation in the prevention of nosocomial diarrhea for a total of eight randomized clinical trials (RCT) involving a grand total of 2 254 children for the age of 1 month to 18 years old.