Probiotic strategies for the treatment and prevention of bacterial vaginosis

Importance of the field: Urogenital infections are on average the number-one reason for women to visit the doctor. Yet, treatment and preventive strategies have gone unchanged for close to 50 years. With prevalence rates for bacterial vaginosis at more than 29%, depending on the population, and similarly high incidences of vulvo-vaginal candidiasis and urinary tract infections, plus HIV, new therapies are urgently needed to improve the health of women around the world.

Areas covered in the review: This review discusses the vaginal microbiota, our improved understanding of its composition, and its role in health and disease. It also discusses the progress made in the past 10 years or so, with the development and testing of probiotic lactobacilli to improve vaginal health and better manage urogenital infection recurrences.

What the reader will gain: The reader will have an understanding of the clinical data obtained so far, and the potential mechanisms of action of probiotics. Despite the need for more clinical studies, the review illustrates a case for inclusion of probiotics as part of the approach to disease prevention, and as an adjunct to antimicrobial treatment. Challenges remain in optimizing clinical benefits, selecting new strains, preparing new products and having them tested in humans then approved with informative claims, and making products readily accessible to women in the developed and developing world.

Take home message: The vaginal microbiota is a complex structure that can change quickly and dramatically, and significantly impact a woman's health. New health-maintenance and disease-treatment approaches are badly needed, and probiotics should be considered.     

Novel application of published risk factors for methicillin-resistant S. aureus in acute bacterial skin and skin structure infections

Methicillin-resistant Staphylococcus aureus acute bacterial skin and skin structure infections (MRSA ABSSSIs) are associated with a significant clinical and economic burden; however, rapid identification of MRSA remains a clinical challenge. This study aimed to use a novel method of predictive modeling to determine those at highest risk of MRSA ABSSSIs. Risk factors for MRSA ABSSSI were derived from a combination of previously published literature and multivariable logistic regression of individual patient data (IPD) using the ‘adaptation method.’ A risk-scoring tool was derived from weight-proportional integer-adjusted coefficients of the predictive model. Likelihood ratios were used to adjust posterior probability of MRSA. Risk factors were identified from 12 previously published studies and adapted based on IPD (n?=?231). Risk factors were: history of diabetes with obesity (adapted odds ratio [aOR]?=?1.1), prior antibiotics (90 days) (aOR?=?2.6), chronic kidney disease/hemodialysis (aOR?=?1.4), intravenous drug use (aOR?=?2.8), previous MRSA exposure/infection (12 months) (aOR?=?2.8), previous hospitalization (12 months) (aOR?=?7.5), and HIV/AIDS (aOR?=?4.0). Baseline prevalence of MRSA was 42.7%. Scores ranged from 0 - 8 points. Post-test probability of MRSA: score 0?=?35.0%; score 1 – 2?=?45.0%; score 3?=?63.0%. The newly derived risk-scoring tool is proof-of-concept of the adaptation method. This study is hypothesis generating and such a tool remains to be validated for clinical use.