https://doi.org/10.4081/gc.2026.15772
21 | The role of prebiotic and probiotic supplementation in the prevention of clostridioides difficile infection
E. Cortese1, E. Del Giudice2, M. Ceci2, A. Cavalli2, U.G. Galasso1, G. Desideri1, L. Palleschi2 | 1Department of Internal Medicine and Medical Specialties, UOC Geriatrics, Sapienza University of Rome, Rome; 2Unit of Geriatrics, Medical Department, San Giovanni-Addolorata Hospital, Rome.
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Published: 11 June 2026
Introduction. Clostridioides difficile infection (CDI) is a frequent healthcare-associated complication in older adults, particularly in patients with multimorbidity and repeated antibiotic exposure. In geriatric care, preventive strategies targeting gut microbiota are gaining increasing attention.
Objectives. To evaluate the association between prebiotic and probiotic supplementation and CDI incidence in hospitalized older patients.
Materials and Methods. We conducted a retrospective observational study in a geriatric ward, including patients discharged between 2023 and 2025. From early 2025, prebiotic and probiotic supplementation was routinely administered to high-risk patients, especially during antibiotic therapy. CDI cases were analyzed annually in relation to total discharges, excluding short-stay admissions.
Results. A progressive reduction in CDI cases was observed: 21 (1 recurrence) in 2023, 15 in 2024, and 11 in 2025. Discharges increased from 755 (2023) to 839 (2024) and 979 (2025). CDI incidence decreased from 2.8 to 1.8 and 1.1 cases per 100 discharges, respectively. The reduction was more evident after supplementation introduction in 2025, despite higher patient volume. Overall, a relative reduction of approximately 48% was observed.
Conclusions. Prebiotic and probiotic supplementation was associated with reduced CDI incidence in hospitalized older adults. Results should be interpreted cautiously due to retrospective design and absence of a control group. However, they support a potential role for microbiota-targeted, low-cost preventive strategies in geriatric practice.
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