Invasive Infections Associated with the Use of Probiotics in Children: A Systematic Review.

Martina D’Agostin,Prisca Da Lozzo,Egidio Barbi,Lotte Wijers,Marzia Lazzerini,Domenica Squillaci

doi:10.3390/children8100924

Martina D’Agostin, Prisca Da Lozzo + Show 4 more

Open Access

https://doi.org/10.3390/children8100924

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Abstract

Although the effectiveness of probiotics has only been proven in specific conditions, their use in children is massively widespread because of their perception as harmless products. Recent evidence raises concerns about probiotics’ safety, especially but not only in the paediatric population due to severe opportunistic infections after their use. This review aimed at summarising available case reports on invasive infections related to probiotics’ use in children. For this purpose, we assessed three electronic databases to identify papers describing paediatric patients with documented probiotic-derived invasive infections, with no language restrictions. A total of 49 case reports from 1995 to June 2021 were identified. The infections were caused by Lactobacillus spp. (35%), Saccharomyces spp. (29%), Bifidobacterium spp. (31%), Bacillus clausii (4%), and Escherichia coli (2%). Most (80%) patients were younger than 2 years old and sepsis was the most observed condition (69.4%). All the patients except one had at least one condition facilitating the development of invasive infection, with prematurity (55%) and intravenous catheter use (51%) being the most frequent. Three (6%) children died. Given the large use of probiotics, further studies aiming at evaluating the real incidence of probiotic-associated systemic infections are warranted.

Highlights

According to the revised definition of the International Scientific Association for Probiotics and Prebiotics (ISAPP), probiotics are “live microorganisms that when administered in adequate amounts, confer a health benefit on the host” [1]
Probiotics have proven to be effective as a preventive intervention for a few specific conditions, such as neonatal necrotising enterocolitis (NEC) and late-onset sepsis (LOS) in premature infants [3,4,5,6]
This review aims to summarise the available evidence on the occurrence of invasive infections, such as sepsis, septic shock, bacteraemia, or pneumonia, associated with probiotics’ use in paediatric patients

Summary

Introduction

According to the revised definition of the International Scientific Association for Probiotics and Prebiotics (ISAPP), probiotics are “live microorganisms that when administered in adequate amounts, confer a health benefit on the host” [1]. Probiotics have proven to be effective as a preventive intervention for a few specific conditions, such as neonatal necrotising enterocolitis (NEC) and late-onset sepsis (LOS) in premature infants [3,4,5,6]. Their benefit in conditions such as diarrhoea, allergic diseases, and infantile colic showed conflicting results and low levels of evidence [7,8,9,10,11,12]. In 2018, a systematic review of 384 randomised controlled trials assessing probiotics and prebiotics found that safety outcomes for these interventions in the literature were often missing, insufficient, or inconsistent; of the 384 trials, 106 (28%)

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