Abstract
BackgroundLittle is studied about complications related to probiotic ingestion. This study proposes to present a synthesis and critical evaluation of the reports and series of cases on the infectious complications related to the ingestion of probiotics, which can raise awareness for the prescribing and use of probiotics for certain groups of patients.MethodsSystematic review of reports and series of cases researched in the PubMed, SciELO and Scopus databases published until August 2018. The references of the articles were investigated manually for the search of cross references. SPSS version 23.0 was used for descriptive statistics and univariate analysis.ResultsWe found 60 case reports and 7 case series, making up a total of 93 patients. Fungemia was the most common infectious complications with 35 (37.6%) cases. The genus Saccharomyces was the most frequent with 47 (50.6%) cases, followed by Lactobacillus, Bifidobacterium, Bacillus, Pedioccocus and Escherichia with 26 (27.9%), 12 (12.8%), 5 (5.4%), 2 (2.2%) and 1 (1.1%) case, respectively. Adults over 60 years of age, Clostridium difficile colitis, antibiotic use and Saccharomyces infections were associated with overall mortality. HIV infections, immunosuppressive drugs, solid organ transplantation, deep intravenous lines, enteral or parenteral nutrition were not associated with death.ConclusionThe use of probiotics cannot be considered risk-free and should be carefully evaluated for some patient groups.Trial registrationCRD42016042289
Highlights
Little is studied about complications related to probiotic ingestion
Inclusion criteria Case reports or case series of patients were included, regardless of health status, age, previous use of probiotics, medication vehicle, presentation or microorganism involved, associated with infection in any system of the human body, with emphasis on the following diagnoses, according to their respective definitions or criteria: (1) bacteremia and fungemia, where microorganisms were isolated in blood [10], (2) sepsis, meaning infection related to the systemic inflammatory response according to the Sepsis Consensus Conference of 1992 [11], (3) endocarditis according to the Duke criteria [12], (4) abscess, when accumulation of purulent material in circumscribed tissues, organs or spaces, associated with signs of infection [13]
S. boulardii, which is marketed in many countries as a medicine to treat gastroenteritis, is considered identical to a S. cerevisiae strain; this fact corroborates the findings of some authors about the compatibility between S. cerevisiae identified in the biological material of the patients and S. boulardii isolated from the probiotics of the respective cases
Summary
Little is studied about complications related to probiotic ingestion. This study proposes to present a synthesis and critical evaluation of the reports and series of cases on the infectious complications related to the ingestion of probiotics, which can raise awareness for the prescribing and use of probiotics for certain groups of patients. Several studies have demonstrated the benefit of probiotics for various diseases, including critically ill patients, in systematic reviews or meta-analyses [2,3,4,5,6]. Our study is a systematic review of case reports and case series evaluating serious infections such as bacteremia, Costa et al BMC Complementary and Alternative Medicine (2018) 18:329 fungemia, sepsis, endocarditis, abscess and other complications in the context of probiotic ingestion. We believe it may bring new evidence to clinical practice and possibly a more conscientious prescribing practice regarding antibiotics and probiotics
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