Elsevier

Nutrition

Volume 31, Issues 7–8, July–August 2015, Pages 1052-1053
Nutrition

Brief report
Antibiotic overuse and Clostridium difficile infections: The Indian paradox and the possible role of dietary practices

https://doi.org/10.1016/j.nut.2015.02.002Get rights and content

Abstract

Antibiotic abuse is rampant in India, such that one may expect to see an increase of Clostridium difficile infections (CDI). However, we found that the incidence of CDI in India (1.67%) is no different from that reported in USA (1.6%) using similar techniques of detection (polymerase chain reaction test). We offer a possible explanation for this paradox. It is likely that a diet rich in fiber, yogurt, and possibly turmeric may have a protective role in decreasing the incidence of CDIs in India.

Section snippets

Antibiotic use in India

An effective and enforceable stewardship program to thwart the abuse of antibiotics, especially to prevent multidrug resistant organisms, does not currently exist in India. A concerted effort through a collaboration of professional societies has recently been launched [1], [2], [3], along the lines of initiatives that have been in place in other countries for several years [4]. Although the medical profession at large and a focused group of specialists (intensivists and infectious diseases

Antibiotics and Clostridium difficile infections

It has been well accepted that antibiotic overuse is one of the major contributing factors to the development of Clostridium difficile infections (CDI) both in the community as well as in hospitals. This has been known for several years and has been reinforced by newer publications [5], [6], [7]. A recent publication showed that nearly half of Medicare beneficiaries admitted with community-acquired CDI had no recent antibiotic exposure, emphasizing the epidemiologic importance of collateral

The paradox

During interactions at professional society meetings in India, comments often are made that the incidence of CDI in India is low. This is felt to be the case across the board including tertiary care hospitals accredited by international accreditation agencies with strict infection control practices and enforceable antibiotic stewardship policies. Therefore, we decided to collect data to determine the actual incidence of CDI in our hospital.

During the period from January 2013 to May 2014, tests

Possible explanations

We offer possible dietary explanations for this paradox: fiber, yogurt, and turmeric. The role of dietary fiber in maintaining the gut microbiota is well known [10], [11]. During the immediate postpartum period, the infant's sterile gut becomes colonized by multiple microorganisms that are actually beneficial for synthesizing vitamins and maintaining the local and systemic immune functions [12], [13]. A good balance between the beneficial microbiota and the potentially pathogenic organisms is a

Conclusion

C. difficile superinfection associated with antibiotic overuse is a global menace sufficient to be branded an epidemic challenge by the CDC. Interestingly, there is a paradox in the Indian environment where antibiotic overuse is frequent. Although this is often mentioned without published data, we confirm that is the reality based on limited data from our institution. The paradox needs to be studied further, but we propose that the Indian diet comprising of fiber, probiotic (yogurt,

References (17)

  • S.Y. Tartof et al.

    Incidence of polymerase chain reaction-diagnosed Clostridium difficile in a large high-risk cohort, 2011 to 2012

    Mayo Clin Proc

    (2014)
  • R.D. Berg

    The indigenous gastrointestinal microflora

    Trends Microbiol

    (1996)
  • A. Ghafur et al.

    The Chennai Declaration: a roadmap to tackle the challenge of antimicrobial resistance

    Indian J Cancer

    (2013)
  • A.H. Holmes et al.

    The Chennai Declaration: India's landmark national commitment to antibiotic stewardship

    J Antimicrob Chemother

    (2013)
  • S.J. Chandy et al.

    ICMR programme on antibiotic stewardship, prevention of infection and control

    Indian J Med Res

    (2014)
  • S.H. Cohen et al.

    Society for Healthcare Epidemiology of America: Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Health care epidemiology of America (SHEA) and the Infections Diseases Society of America (IDSA)

    Infect Control Hosp Epidemiol

    (2010)
  • J.G. Bartlett

    Narrative review: the new epidemic of Clostridium difficile-associated enteric disease

    Ann Intern Med

    (2006)
  • K.S. Brown et al.

    Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection

    Antimicrobial Agents Chemother

    (2013)
There are more references available in the full text version of this article.

Cited by (7)

  • Clostridioides difficile epidemiology in India

    2022, Anaerobe
    Citation Excerpt :

    Although diet is among the most powerful available tools for affecting the health of humans and their relationship with their microbiota, investigation into the effects of diet on human CDI is still lacking. In Indian society, it has been postulated that a diet which is rich in fiber, yoghurt, buttermilk, and possibly turmeric may have a protective role in mediating colonization resistance against CDI despite the rampant use of antibiotics [56]. Indian cuisine is also high in carbohydrate content and indeed several studies have suggested that high-carbohydrate, low-protein diets can mitigate antibiotic-induced CDI in mice [57].

  • Status of vaccine research and development for Clostridium difficile

    2019, Vaccine
    Citation Excerpt :

    Only 4/25 studies were multi-institutional. Individual studies within particular hospitals in Asian countries such as Indonesia [37], Thailand [38] and South Korea [39] suggested the organism is widespread and capable of causing clinical disease, although given the widespread availability of antibiotics, the number of cases was lower than expected. In sub-Saharan Africa, carriage of toxigenic strains linked to diarrhoeal disease, antibiotic usage and HIV status have been reported in the few studies that have been performed [40].

  • Safety Evaluation of Lactic Acid Bacteria

    2019, Lactic Acid Bacteria: Omics and Functional Evaluation
View all citing articles on Scopus
View full text