Incidence and outcomes of bloodstream infections among hematopoietic cell transplant recipients from species commonly reported to be in over-the-counter probiotic formulations
Open accessAbstract
Background: Probiotic supplementation has been promoted for numerous health conditions; however, safety in immunosuppressed patients is unknown. We evaluated bloodstream infections (BSI s) caused by common probiotic organisms in hematopoietic cell transplant recipients. Methods: All blood culture (BC) results from a cohort of hematopoietic cell transplant recipients transplanted at Fred Hutchinson Cancer Research Center in Seattle, Washington, between 2002 and 2011 were reviewed. Patients with at least 1 positive BC for common probiotic organisms (L actobacillus species, B ifidobacterium species, S treptococcus thermophilus, and S accharomyces species) within 1 year post hematopoietic cell transplantation (HCT) were considered cases. Data were collected from center databases, which contain archived laboratory data, patient demographics, and clinical summaries. Results: A total of 19/3796 (0.5%) patients developed a BSI from one of these organisms within 1 year post HCT; no B ifidobacterium species or S. thermophilus were identified. Cases had a median age of 49 years (interquartile range [IQR]: 39–53), and the majority were allogeneic hematopoietic cell transplant recipients (14/19, 74%). Most positive BC s were L actobacillus species (18/19) and occurred at a median of 84 days (IQR: 34–127) post transplant. The incidence rate of L actobacillus bacteremia was 1.62 cases per 100,000 patient‐days; the highest rate occurred within 100 days post transplant (3.3 per 100,000 patient‐days). Eight patients (44%) were diagnosed with acute graft‐versus‐host disease of the gut prior to the development of bacteremia. No mortality was attributable to any of these infections. Conclusion: Organisms frequently incorporated in available over‐the‐counter probiotics are infrequent causes of bacteremia after HCT. Studies evaluating the use of probiotics among high‐risk patients are needed.
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The prevalence of LB is 0.1-0.2% of all isolates identified in blood cultures from hospitalized patients and 0.5% of blood isolates from immunocompromised patients.
“The prevalence of LB is generally low, comprising 0.1–0.2% of all isolates identified in blood cultures from hospitalized patients and 0.5% of blood isolates from immunocompromised patients [2,10,18,19,20].”
From Lactobacillus Bacteremia and Probiotics: A Review (2023) · cites this paper as [10]
The Results (page unavailable) report that 19/3796 (0.5%) hematopoietic cell transplant recipients had a blood culture positive for an organism commonly found in probiotics, usually Lactobacillus. This supports the general point that such infections were rare, but 0.5% is a proportion of patients, not of blood isolates from immunocompromised patients generally. The paper does not report the claimed 0.1–0.2% of isolates from hospitalized patients. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn hematopoietic cell transplant recipients, the incidence of LB was 1.6 cases/100,000 patient days.
“In one study of a cohort of hematopoietic cell transplant recipients at a hospital in Seattle, Washington, between 2002 and 2011, the incidence of LB was 1.6 cases/100,000 patient days [10].”
From Lactobacillus Bacteremia and Probiotics: A Review (2023) · cites this paper as [10]
The source of these infections has sometimes been attributed to the use of Lactobacillus-containing probiotics.
“The source of these infections has sometimes been attributed to the use of Lactobacillus-containing probiotics [9,10,11].”
From Lactobacillus Bacteremia and Probiotics: A Review (2023) · cites this paper as [10]
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- Authors
- Cohen, S. A., Woodfield, M. C., Boyle, N., Stednick, Z., Boeckh, M., & Pergam, S. A.
- Affiliations
- University of Washington (US)
- Fred Hutch Cancer Center (US)
- Seattle Cancer Care Alliance (US)
- Corresponding author
- Pergam, S.A.
- Venue
- Transplant Infectious Disease
- Publisher
- Wiley
- Published
- 2016-09-21
- Volume
- 18
- Issue
- 5
- Pages
- 699-705
- ISSN
- 1398-2273 (ISSN-L)
- 1399-3062
- PMC
- PMC5160044
- OpenAlex
- W2482727545
- Cited by
- 75
- References
- 27
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 6 · 2023: 12 · 2022: 9 · 2021: 7 · 2020: 7 · 2019: 7 · 2018: 6 · 2017: 5
- FWCI
- 7.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Transplant Infectious Disease (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K24HL093294)
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Keywords
- bloodstream infection, hematopoietic cell transplant recipients, probiotics, immunosuppression, allogeneic transplantation, graft-versus-host disease, Streptococcus thermophilus, Saccharomyces, Bifidobacterium, infection incidence
- MeSH terms
- Blood Culture, Adult, Aged, Bifidobacterium, Child, Child, Preschool, Nonprescription Drugs, Female, Graft vs Host Disease, Humans, Immunosuppression Therapy, Lactobacillus, Male, Middle Aged, Retrospective Studies, Saccharomyces cerevisiae, Transplantation, Homologous, Incidence, Bacteremia, Hematopoietic Stem Cell Transplantation, Probiotics, Streptococcus thermophilus, Young Adult, Transplant Recipients
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