Lactobacillus Bacteremia, Clinical Significance, and Patient Outcome, with Special Focus on Probiotic L. Rhamnosus GG

• Published in: Clinical infectious diseases Vol. 38; no. 1; pp. 62 - 69
• Main Authors: Salminen, Minna K., Rautelin, Hilpi, Tynkkynen, Soile, Poussa, Tuija, Saxelin, Maija, Valtonen, Ville, Järvinen, Asko
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.01.2004; University of Chicago Press
• Subjects: Anti-Bacterial Agents - therapeutic use; Antimicrobials; Bacteremia; Bacteremia - drug therapy; Bacteremia - microbiology; Bacteremia - mortality; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Blood; Endocarditis; Female; Human bacterial diseases; Humans; Infections; Infectious diseases; Lactobacillus; Lactobacillus rhamnosus; Major Articles; Male; Medical sciences; Middle Aged; Mortality; Multivariate Analysis; Operating rooms; Predisposing factors; Probiotics; Probiotics - adverse effects; Prognosis; Multivariate analysis; Characterization; Microbiological investigation; Surgery; Bacteria; Lactobacillaceae; Blood culture; C reactive protein; Lactobacillus; Human; Probiotic; Critically ill; Mortality; Hospitalization; Bacteremia; Fatal course; Infection; Symptomatology; Immunosuppression; Acute phase protein; Risk factor; Bacteriosis; Predictive factor; Bibliographic review; Prolonged
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/380455

Lactobacillus bacteremia is a rare entity, and its clinical significance is poorly defined. We have reviewed the risk factors and outcome for 89 case patients with Lactobacillus bacteremia. Species characterization was done in 53% of the cases, revealing 25 L. rhamnosus strains and 22 other Lactobacillus species. In 11 cases, the strain was identical with the probiotic L. rhamnosus GG. In 82% of the cases, the patients had severe or fatal comorbidities. Predisposing factors to bacteremia were immunosuppression, prior prolonged hospitalization, and prior surgical interventions. No significant differences were observed in these predisposing factors or clinical features between patients with cases associated with the various Lactobacillus species, other than higher C-reactive protein values in patients with L. rhamnosus bacteremia. Mortality was 26% at 1 month and was 48% at 1 year. In multivariate analysis, severe underlying diseases were a significant predictor for mortality (odds ratio [OR], 15.8), whereas treatment with antimicrobials effective in vitro was associated with lower mortality (OR, 0.22). We conclude that lactobacilli in blood cultures are of clinical significance and that their susceptibility should guide decisions about antimicrobial treatment.