Brief reportAntibiotic overuse and Clostridium difficile infections: The Indian paradox and the possible role of dietary practices
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,
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Cited by (7)
Clostridioides difficile epidemiology in India
2022, AnaerobeCitation 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, VaccineCitation 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].
Antibiotic resistant bacteria: A bibliometric review of literature
2022, Frontiers in Public HealthClostridium difficile-associated Diarrhea in Developing Countries: A Systematic Review and Meta-Analysis
2019, Infectious Diseases and TherapySafety Evaluation of Lactic Acid Bacteria
2019, Lactic Acid Bacteria: Omics and Functional EvaluationClostridioides difficile incidence related to in-hospital cephalosporin use: A tale of two highly comparable hospitals
2019, Journal of Antimicrobial Chemotherapy