Backgrounds/Aims: To clarify the usefulness of Lactobacillus casei strain Shirota (LcS)-fermented milk in the normalization of bowel movements and improvement of infection control for the elderly residents and staff of facilities for the elderly. Methods: A randomized placebo-controlled double-blind test was performed among the elderly residents (average age, 85) and staff members (average age, 37) of facilities for the elderly. The participants randomly received either LcS-fermented milk or a placebo beverage once daily for 6 months. Clinical data and enteric conditions were compared between the 2 groups. Results: A significantly lower incidence of fever and improved bowel movements were seen in the LcS-fermented milk group (n = 36) in comparison to the placebo group (n = 36). The numbers of Bifidobacterium and Lactobacillus were significantly higher (p < 0.01), the numbers of destructive bacteria such as Clostridium difficile were significantly lower (p < 0.05), and the fecal acetic acid concentration and total acidity were significantly higher in the LcS group. A significant difference in the intestinal microbiota, fecal acetic acid, and pH was also observed between the LcS and placebo groups among the facility's staff members. Conclusions: The long-term consumption of LcS-fermented milk may be useful for decreasing the daily risk of infection and improving the quality of life among the residents and staff of facilities for the elderly.

Keywords:
Lactobacillus casei strain Shirota, Infection control, Fecal microbiota, Aged care facility residents, Bowel movements
1.
Jakobsen R, Sørlie V: Dignity of older people in a nursing home: narratives of care providers. Nurs Ethics 2010;17:289-300.
2.
Johanson JF, Irizarry F, Doughty A: Risk factors for fecal incontinence in a nursing home population. J Clin Gastroenterol 1997;24:156-160.
3.
Gerba CP, Rose JB, Haas CN: Sensitive populations: who is at the greatest risk? Int J Food Microbiol 1996;30:113-123.
4.
Strausbaugh LJ, Jacobson C, Sewell DL, Potter S, Ward TT: Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a veterans affairs nursing home care unit. Infect Control Hosp Epidemiol 1992;13:151-159.
5.
Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E: Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38(5 suppl 1):S25-S33.
6.
Takeda K, Suzuki T, Shimada SI, Shida K, Nanno M, Okumura K: Interleukin-12 is involved in the enhancement of human natural killer cell activity by Lactobacillus casei Shirota. Clin Exp Immunol 2006;146:109-115.
7.
Sugawara G, Nagino M, Nishio H, Ebata T, Takagi K, Asahara T, Nomoto K, Nimura Y: Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg 2006;244:706-714.
8.
Aso Y, Akaza H, Kotake T, Tsukamoto T, Imai K, Naito S: Preventive effect of a Lactobacillus casei preparation on the recurrence of superficial bladder cancer in a double-blind trial. The BLP Study Group. Eur Urol 1995;27:104-109.
9.
Tamura M, Shikina T, Morihana T, Hayama M, Kajimoto O, Sakamoto A, Kajimoto Y, Watanabe O, Nonaka C, Shida K, Nanno M: Effects of probiotics on allergic rhinitis induced by Japanese cedar pollen: randomized double-blind, placebo-controlled clinical trial. Int Arch Allergy Immunol 2007;143:75-82.
10.
Shimoyama T, Honi S, Tamura K, Yamamura M, Tanaka M, Yamazaki K: Microflora of patients with stool abnormality. Bifidobacteria Micoflora 1984;3:35-42.
11.
Nagata S, Asahara T, Ohta T, Yamada T, Kondo S, Bian L, Wang C, Yamashiro Y, Nomoto K: Effect of the continuous intake of probiotic-fermented milk containing Lactobacillus casei strain Shirota on fever in a mass outbreak of norovirus gastroenteritis and the faecal microflora in a health service facility for the aged. Br J Nutr 2011;106:549-556.
12.
Bian L, Nagata S, Asahara T, Rahman MS, Ohta T, Yuki N, Wang C, Takano K, Daibo M, Yamashiro Y, Nomoto K: Effects of continuous intake of Lactobacillus casei strain Shirota-fermented milk on risk management of long-term inpatients at health service facilities for the elderly. Int J Probiotics Prebiotics 2011;6:123-132.
13.
Matsuda K, Tsuji H, Asahara T, Kado Y, Nomoto K: Sensitive quantitative detection of commensal bacteria by rRNA-targeted reverse transcription-PCR. Appl Environ Microbiol 2007;73:32-39.
14.
Matsuda K, Tsuji H, Asahara T, Takahashi T, Kubota H, Nagata S, Yamashiro Y, Nomoto K: Sensitive quantification of Clostridium difficile cells by reverse transcription-quantitative PCR targeting rRNA molecules. Appl Environ Microbiol 2012;78:5111-5118.
15.
Wada M, Lkhagvadorj E, Bian L, Wang C, Chiba Y, Nagata S, Shimizu T, Yamashiro Y, Asahara T, Nomoto K: Quantitative reverse transcription-PCR assay for the rapid detection of methicillin-resistant Staphylococcus aureus. J Appl Microbiol 2010;108:779-788.
16.
Fujimoto J, Matsuki T, Sasamoto M, Tomii Y, Watanabe K: Identification and quantification of Lactobacillus casei strain Shirota in human feces with strain-specific primers derived from randomly amplified polymorphic DNA. Int J Food Microbiol 2008;126:210-215.
17.
Kamiya S, Nagino M, Kanazawa H, Komatsu S, Mayumi T, Takagi K, Asahara T, Nomoto K, Tanaka R, Nimura Y: The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg 2004;239:510-517.
18.
Darcy-Vrillon B, Cherbuy C, Morel MT, Durand M, Duée PH: Short chain fatty acid and glucose metabolism in isolated pig colonocytes: modulation by NH4+. Mol Cell Biochem 1996;23:145-151.
19.
Eklund T: The antimicrobial effect of dissociated and undissociated sorbic acid at different pH levels. J Appl Bacteriol 1983;54:383-389.
20.
Fukuda S, Toh H, Hase K, Oshima K, Nakanishi Y, Yoshimura K, Tobe T, Clarke JM, Topping DL, Suzuki T, Taylor TD, Itoh K, Kikuchi J, Morita H, Hattori M, Ohno H: Bifidobacteria can protect from enteropathogenic infection through production of acetate. Nature 2011;469:543-547.
21.
Nagao F, Nakayama M, Muto T, Okumura K: Effects of a fermented milk drink containing Lactobacillus casei strain Shirota on the immune system in healthy human subjects. Biosci Biotechnol Biochem 2000;64:2706-2708.
22.
Matsuzaki T, Saito M, Usuku K, Nose H, Izumo S, Arimura K, Osame M: A prospective uncontrolled trial of fermented milk drink containing viable Lactobacillus casei strain Shirota in the treatment of HTLV-1 associated myelopathy/tropical spastic paraparesis. J Neurol Sci 2005;237:75-81.
23.
Gleeson M, Bishop NC, Oliveira M, Tauler P: Daily probiotic's (Lactobacillus casei Shirota) reduction of infection incidence in athletes. Int J Sport Nutr Exerc Metab 2011;21:55-64.
24.
Yokokura T, Yajima T, Hashimoto S: Effect of organic acid on gastrointestinal motility of rat in vitro. Life Sci 1977;21:59-62.
25.
Kyne L, Hamel MB, Polavaram R, Kelly CP: Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002;34:346-353.
26.
Wada A, Masuda Y, Fukayama M, Hatakeyama T, Yanagawa Y, Watanabe H, Inamatsu T: Nosocomial diarrhoea in the elderly due to enterotoxigenic Clostridium perfringens. Microbiol Immunol 1996;40:767-771.
27.
Hofstra H, Witholt B: Kinetics of synthesis, processing, and membrane transport of heat-labile enterotoxin, a periplasmic protein in Escherichia coli. J Biol Chem 1984;259:15182-15187.
28.
Lin Z, Kotler DP, Schlievert PM, Sordillo EM: Staphylococcal enterocolitis: forgotten but not gone? Dig Dis Sci 2010;55:1200-1207.
29.
Asahara T, Nomoto K, Shimizu K, Watanuki M, Tanaka R: Increased resistance of mice to Salmonella enterica serovar Typhimurium infection by synbiotic administration of bifidobacteria and transgalactosylated oligosaccharides. J Appl Microbiol 2001;91:985-996.
30.
Asahara T, Shimizu K, Nomoto K, Watanuki M, Tanaka R: Antibacterial effect of fermented milk containing Bifidobacterium breve, Bifidobacterium bifidum and Lactobacillus acidophilus against indigenous Escherichia coli infection in mice. Microb Ecol Health Dis 2001;13:16-24.
31.
Lkhagvadorj E, Nagata S, Wada M, Bian L, Wang C, Chiba Y, Yamashiro Y, Shimizu T, Asahara T, Nomoto K: Anti-infectious activity of synbiotics in a novel mouse model of methicillin-resistant Staphylococcus aureus infection. Microbiol Immunol 2010;54:265-275.
32.
Ostling CE, Lindgren SE: Inhibition of enterobacteria and Listeria growth by lactic, acetic and formic acids. J Appl Bacteriol 1993;75:18-24.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.