Safety of probiotics in patients receiving nutritional support: A systematic review of case reports, randomized controlled trials, and nonrandomized trials
Open accessAbstract
Background Probiotics are increasingly used in patients receiving nutritional support; however, some case reports and trials have questioned their safety in such patients.Objective The objective was to investigate the safety of probiotics in patients receiving nutritional support through a systematic review of case reports, randomized controlled trials (RCTs), and nonrandomized trials.Design The systematic review followed Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Six electronic databases were searched, a hand search of conference proceedings and reference lists was performed, and experts were contacted. Case reports, RCTs, and nonrandomized trials of probiotic use in patients also receiving enteral or parenteral nutrition were included in the review. Two reviewers independently screened the relevant articles and extracted the data.Results In total, 1966 articles were identified, of which 72 fulfilled the inclusion criteria. There were 20 case reports of adverse events in 32 patients, all of which were infections due to Lactobacillus rhamnosus GG or Saccharomyces boulardii; the risk factors included central venous catheters and disorders associated with increased bacterial translocation. There were 52 articles reporting 53 trials in which 4131 patients received probiotics. Most trials showed either no effect or a positive effect on outcomes related to safety (eg, mortality and infections). Only 3 trials showed increased complications, which were largely noninfectious in nature and in specific patient groups (eg, transplant and pancreatitis). In 2 of these trials, the probiotic was administered through a postpyloric tube.Conclusion Many probiotics have been used safely in patients receiving nutritional support, although some probiotic products (strains or combinations) have been shown to increase the risk of complications in specific patient groups.
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Studies involving mixed or high-risk populations, including patients receiving parenteral nutrition, those in intensive care, or patients with cancer, describe rare but serious adverse events.
“In contrast, studies involving mixed or high-risk populations, including patients receiving parenteral nutrition, those in intensive care, or patients with cancer, describe rare but serious adverse events in detail [73].”
From Current Concepts in Probiotic Safety and Efficacy (2026) · cites this paper as [73]
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References 109 · Cited by 161
Research works printed but not linked: 9
- Salminen MK, Tynkkynen S, Rautelin H, et al. Lactobacillus bacter- emia during a rapid increase in probiotic use of Lactobacillus rham- nosus GG in Finland. Clin Infect Dis 2002;35:1155-60.
- Liong MT. Safety of probiotics: translocation and infection. Nutr Rev 2008;66:192-202.
- Viggiano M, Badetti C, Bernini V, Garabedian M, Manelli JC. Fon- ge ´mie a `Saccharomyces boulardii chez un bru ˆle ´grave. [Saccharomyces boulardii fungemia in a patient with severe burns.] Ann Fr Anesth Reanim 1995;14:356-8 (in French).
- Lestin F, Pertschy A, Rimek D. Funga ¨mie nach oraler Gabe Saccha- romyces boulardii bei einem multimorbiden Patienten. [Fungemia after oral treatment with Saccharomyces boulardii in a patient with multiple comorbidities.] Dtsch Med Wochenschr 2003;128:2531-3 (in German).
- Mihatsch WA, Vossbeck S, Franz AR, Kron M, Pohlandt F. Effect of enteral administration of a probiotic strain of bifidobacteria on the incidence of nosocomial infections in preterm infants. Pediatr Res 2004;55:448A.
- Schlotterer M, Bernasconi P, Lebreton F, Wassermann D. Inte ´re ˆt de Saccharomyces boulardii dans la tole ´rance digestive de la nutrition ente ´rale a `de ´bit continu chez le bru ˆle ´. [Use of Saccharomyces boulardii for the improvement of the tolerance of continuous enteral feeding in burn patients.] Nutr Clin Metab 1987;1:31-4 (in French).
- Satoh K, Shinohara H, Umezaki H, et al. Bifidobacteria prevents necrotizing enterocolitis and infection in preterm infants. Int J Prob Preb 2007;2:149-54.
- Laviano A, Pennacchiotti ML, Baisi F, et al. Reduced need for par- enteral nutrition in intensive care unit by enteral nutrition supple- mented with probiotic. Clin Nutr 2004;23:S1466.
- Kubota A, Kawahara H, Hasegawa T, et al. The efficacy of synbiotics on chronic intestinal pseudo-obstruction syndrome in children. J Pa- renter Ent Nutr 2007;31:S63-4.
- Authors
- Whelan, K., & Myers, C. E.
- Affiliations
- King's College London (GB)
- ORCID
- Whelan, Kevin
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 91
- Issue
- 3
- Pages
- 687-703
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2101645084
- Cited by
- 161
- References
- 109
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 6 · 2022: 7 · 2021: 4 · 2020: 7 · 2019: 8 · 2018: 7 · 2017: 11 · 2016: 10 · 2015: 12 · 2014: 20 · 2013: 17 · 2012: 21
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- King's College London
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
- Keywords
- probiotics, probiotic safety, nutritional support, enteral nutrition, parenteral nutrition, Lactobacillus rhamnosus GG, Saccharomyces boulardii, bacterial translocation, central venous catheters, infection, transplant recipients, pancreatitis
- MeSH terms
- Clinical Trials as Topic, Humans, Infections, Risk Factors, Saccharomyces, Nutritional Support, Probiotics, Lacticaseibacillus rhamnosus
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