Randomized controlled trials (RCTs) reporting incidence outcomes for healthcare-associated diarrhea were considered for inclusion. Participants had to be children aged 1 month to 18 years who were admitted to the hospital for any reason other than gastrointestinal infections. The interventions of

interest compared use of probiotics (any Nutlin-3a mw strain or dose) versus placebo or no treatment for the prevention of healthcare-associated diarrhea. The primary outcome measure was the incidence of healthcare-associated diarrhea as defined by the investigators. The secondary outcome measures were the incidence of rotavirus gastroenteritis, the incidence of asymptomatic rotavirus infection, the duration of diarrhea, and the duration of hospitalization. We searched MEDLINE, EMBASE, The Cochrane Library, including the Cochrane Central Register of Controlled Trials, Health Source: Nursing/Academic edition, and reference lists, with no language restrictions, through June 2013. The search strategy included the use of a validated filter

for identifying RCTs, which was combined with a topic-specific strategy using the following PubMed MeSH terms: 1. (prevention OR prevent OR prevent* OR preventive therapy OR prophylaxis); 2. (diarrhea OR diarrhoe* OR diarhe* OR dysenter* OR gastro enteritis OR diarrhea OR diarrh* OR gastritis OR gastrit* OR gastroenteritis OR gastroenterocolitis OR vomit* OR intestinal infection* OR gastrointestinal infection* OR rotavirus); 3. (lactobacillus OR lactobacill* OR l acidophilus selleck screening library OR l casei OR l delbrueckii OR l helveticus OR l johnsonii OR l paracasei OR l plantarum OR l reuteri OR l rhamnosus OR l salivarius); 4. (Sacharomyces OR saccharomyce* oxyclozanide OR s bulardii OR streptococcus OR streptococc* AND thermophilus OR enterococcus OR enterococc* AND faecium); 5. (Bifidobacterium

OR bifidobacter* OR b animalis OR b bifidum OR b breve OR b infantis OR b lactis OR b longum); 6. 3 OR 4 OR 5; 7. 6 AND 1 AND 2. In addition, we searched two trial registries (ClinicalTrials.gov, www.clinicaltrials.gov, and EU Clinical Trials Register, www.clinicaltrialsregister.eu). Using a standardized data extraction form, one author (MW) extracted the following data items: author, year of publication, language, study setting, methodological design, exclusion criteria for participants, patient characteristics (age, diagnosis), number of patients allocated to each group, types of interventions, and outcome measures. The data were entered into a computer program. The Cochrane Review Manager (RevMan) (version 5.2.6 Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2013) was used for statistical analysis and to perform a meta-analysis of the RCTs.