Does probiotic bacteremia in premature infants impact clinically relevant outcomes? A case report and updated review of literature. (October 2020)

• Record Type: Journal Article
• Authors: Pillai, Anish; Tan, Jason; Paquette, Vanessa; Panczuk, Julia
• Is Part Of: Clinical nutrition ESPEN. Volume 39(2020)
• Page Start: 255
• Page End: 259
• Publication Date: 2020-10
• Subjects: Bifidobacterium -- Preterm -- NEC -- Probiotics -- Septicemia; NEC necrotizing enterocolitis -- NICU neonatal intensive care unit -- VLBW very low birth weight -- DOL day of life -- MOM mother's own milk -- HMF human milk fortifier -- POD post operative day -- CRP C-reactive protein -- CGA corrected gestational age; Nutritionally induced diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; 616.39005
• DOI: 10.1016/j.clnesp.2020.05.020
• Languages: English
• ISSNs: 2405-4577

Abstract

Summary: Prophylactic use of probiotics decreases the incidence of necrotizing enterocolitis (NEC) in premature infants. However, there are ongoing concerns related to the routine use of probiotics including inconsistent literature regarding optimal dose and strain, lack of regulatory standards in production and reports regarding potential side effects. There is limited data regarding the incidence of probiotic bacteremia and its impact on relevant clinical outcomes in the premature population. We report the first case of Bifidobacterium longum bacteremia in our center since the routine introduction of probiotics. The neonate had NEC with perforation on day of life 7, which likely led to translocation of the probiotic strain to the blood stream. The neonate did not have any hemodynamic instability and the repeat blood culture was negative after starting antibiotic therapy. We also conducted a literature review and found 13 other cases of probiotic bacteremia in premature or very low birth weight neonates. Although the incidence of probiotic bacteremia is low, it can impact several clinical outcomes including prolonged exposure to antibiotics, removal of central lines and additional laboratory testing such as lumbar puncture. There has been no mortality attributable to probiotic bacteremia and there is no data regarding long term neurodevelopmental outcomes. Highlights: First case report of bacteremia related to probiotics in Canada used for NEC prevention in preterm infants. Describes relevant clinical outcomes in the preterm population affected by probiotic bacteremia. Provides literature review of probiotic related bacteremia cases among preterm infants.