Incidence of Saccharomyces cerevisiae fungemia in hospitalised patients administered Saccharomyces boulardii probiotic.

Abstract

Bloodstream infection is an untoward effect of probiotic administration described by case reports and a cited reason to avoid using in the critically ill. The incidence rate of bloodstream infection in a population administered probiotics remains unknown. A retrospective observational analysis of incident Saccharomycescerevisiae fungemia in a population of hospitalised patients administered Saccharomycesboulardii for primary prevention of hospital-onset Clostridioidesdifficile infection. Adult patients admitted to an inpatient medical unit for 48-h or more between January 1, 2016 and December 31, 2019 are included. Facility medication administration records and microbiology records were evaluated for Sboulardii probiotic administration and incidence of Scerevisiae positive blood cultures. Microbiologic identification methods were unable to distinguish Scerevisiae from Sboulardii. Administration of Sboulardii probiotic occurred in 16,404 of 46,729 patients analysed. Scerevisiae fungemia was identified in 18 probiotic recipients (0.11%). The observed incidence of fungemia attributable to Sboulardii administration is 1.70 cases per 10,000 patient-days. Central-line days numbered 52,949 yielding an incidence of 0.26 cases of Scerevisiae per 1,000 central-line days. Intensive care unit admission was significantly associated with an increase in the risk of Scerevisiae (OR 6.55, CI 2.28-18.87), incidence rate of 0.47 cases per 1,000 patient-days. The risk of bloodstream infection as a result of Sboulardii probiotic use appears restricted to Sboulardii recipients. The risk for probiotic-related bloodstream infection does not appear greater than the risk of any hospital-acquired bloodstream infection both inside and outside of the intensive care unit.