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Infectious complications following probiotic ingestion: a potentially underestimated problem? A systematic review of reports and case series.
Costa, RL, Moreira, J, Lorenzo, A, Lamas, CC
BMC complementary and alternative medicine. 2018;18(1):329
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This article is a systematic review of case reports and case series published between 1976 and 2018, evaluating serious infections in the context of probiotic intake. The authors found 67 articles, 60 case reports and 7 case series, corresponding to 93 patients. Whilst they believe that these cases represent only a small proportion of existing cases, they also point out that the proportion of cases of infectious complications is small when the total number of people who use probiotics is considered. Fungemia was the most commonly observed complication, with 37.6% of the cases, sepsis was identified in 31.2% patients; bacteraemia was responsible for 20.4% of cases, followed by endocarditis and abscess, with 4 and 3 cases, respectively. Of the fungal complications, 50.5% were due to Saccharomyces spp., Lactobacillus spp. were the etiologic agents in 26 and Bifidobacterium in 12 cases of infectious complications. Infectious complications were more likely in the elderly, children under 1 (especially premature babies), and patients with central venous access or receiving enteral or parenteral nutrition. Immunosuppressive medication was reported in 15% of patients and antibiotic use in 43%. All-cause mortality was 19.6%. The authors conclude that the use of probiotics cannot be considered risk free and should be carefully evaluated for high-risk groups of patients.
Abstract
BACKGROUND Little is studied about complications related to probiotic ingestion. This study proposes to present a synthesis and critical evaluation of the reports and series of cases on the infectious complications related to the ingestion of probiotics, which can raise awareness for the prescribing and use of probiotics for certain groups of patients. METHODS Systematic review of reports and series of cases researched in the PubMed, SciELO and Scopus databases published until August 2018. The references of the articles were investigated manually for the search of cross references. SPSS version 23.0 was used for descriptive statistics and univariate analysis. RESULTS We found 60 case reports and 7 case series, making up a total of 93 patients. Fungemia was the most common infectious complications with 35 (37.6%) cases. The genus Saccharomyces was the most frequent with 47 (50.6%) cases, followed by Lactobacillus, Bifidobacterium, Bacillus, Pedioccocus and Escherichia with 26 (27.9%), 12 (12.8%), 5 (5.4%), 2 (2.2%) and 1 (1.1%) case, respectively. Adults over 60 years of age, Clostridium difficile colitis, antibiotic use and Saccharomyces infections were associated with overall mortality. HIV infections, immunosuppressive drugs, solid organ transplantation, deep intravenous lines, enteral or parenteral nutrition were not associated with death. CONCLUSION The use of probiotics cannot be considered risk-free and should be carefully evaluated for some patient groups. TRIAL REGISTRATION CRD42016042289.