Multiple Lactobacillus Infections Caused by Probiotics at Pediatric and Adult Academic Medical Centers.

Allison M Samuel, Matthew G Lammers, Joshua Nachreiner, Monica C Bogenschutz, Kirsten Koffarnus, Lucas Schulz, Kristin A Shadman, Joseph A McBride
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Abstract

Background: Probiotics are synthetic oral supplements containing live bacterial and fungal species hypothesized to help with various gastrointestinal conditions. However, they can cause infection if the organism spreads outside of the gastrointestinal tract. The aim of this study was to identify and describe patients who experienced systemic infections caused by probiotic use.

Methods: This study was a retrospective chart review of pediatric and adult patients at academic medical centers who received probiotics and subsequently developed positive cultures from a sterile site for probiotic-related species. Two individuals completed the chart reviews to determine if the probiotic was the true cause of the infection.

Results: Lactobacillus, Bifidobacterium, and Saccharomyces cultures were reviewed, with a total of 71, 8, and 2 cultures isolated from sterile sites for each organism, respectively. Further review revealed 23 Lactobacillus cultures from 13 unique patients who were taking Lactobacillus-containing probiotics. Four patients without gastrointestinal tract compromise were included in the final analysis, including 1 patient whose culture was confirmed as identical to the probiotic. Types of infections included meningitis and bacteremia. Targeted antimicrobial therapy included ampicillin, ampicillin-sulbactam, and piperacillin-tazobactam, with total durations of therapy ranging from 10 to 22 days. No patients had mortality attributed to Lactobacillus infection.

Conclusions: Probiotics are not harmless supplements as they come with risk of serious infection as demonstrated in this review. Before use, the risks of probiotics should be considered carefully for each individual patient. Clinicians should consider avoiding probiotics in hospitalized patients, especially those with vascular or extra-ventricular access devices.

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儿科和成人学术医疗中心使用益生菌引起的多种乳酸杆菌感染。
背景:益生菌是一种人工合成的口服补充剂,含有活细菌和真菌物种,据推测有助于治疗各种胃肠道疾病。然而,如果益生菌扩散到胃肠道之外,就会引起感染。本研究旨在识别和描述因使用益生菌而导致全身感染的患者:本研究对学术医疗中心的儿童和成人患者进行了回顾性病历审查,这些患者接受了益生菌治疗,随后无菌部位的益生菌相关菌种培养呈阳性。两人完成了病历审查,以确定益生菌是否是感染的真正原因:结果:对乳酸杆菌、双歧杆菌和酵母菌培养物进行了复查,从无菌部位分离出的每种生物的培养物总数分别为 71、8 和 2 个。进一步审查发现,有 13 名患者服用了含乳酸杆菌的益生菌,他们共培养出 23 个乳酸杆菌。最终分析包括四名没有胃肠道感染的患者,其中一名患者的培养物被证实与益生菌相同。感染类型包括脑膜炎和菌血症。针对性抗菌治疗包括氨苄西林、氨苄西林-舒巴坦和哌拉西林-他唑巴坦,总治疗时间为 10-22 天。没有患者因乳酸杆菌感染而死亡:本综述表明,益生菌并非无害的补充剂,因为它们存在严重感染的风险。在使用益生菌之前,应仔细考虑每位患者的风险。临床医生应考虑避免在住院患者中使用益生菌,尤其是那些有血管或心室外通路装置的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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