Probiotic

Apr 23, 2023

Mayer, Scott MD1; Bonhag, Colin DO1; Jenkins, Patrick MD2; Cornett, Brendon MPH3; Watts, Paula DO1,4; Scherbak, Dmitriy DO1,4

1 HCA HealthONE, Denver, CO.

2 Department of Pulmonary and Critical Care, University of Oklahoma, Oklahoma City, OK.

3 HCA Healthcare, Nashville, TN.

4 Critical Care and Pulmonary Consultants, Greenwood Village, CO.

The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Dr. Mayer acts as guarantor for the content of this article. Dr. Jenkins contributed to the conceptualization of the study. Dr. Mayer wrote the original draft of the article. Dr. Bonhag, Mr. Cornett, Dr. Watts, and Dr. Scherbak reviewed and edited the article. Dr. Mayer, Dr. Bonhag, Mr. Cornett, Dr. Watts, and Dr. Scherbak contributed to the data acquisition and interpretation. All authors critically reviewed the article before submission.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal).

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity.

Mr. Cornett received funding from HCA Healthcare. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

To determine the occurrence rate and impact on patient outcomes of probiotic-associated central venous catheter bloodstream infections in the ICU.

Retrospective observational cohort study.

The cohort was gathered using HCA Healthcare's data warehouse.

Adult patients with central venous catheters in the ICU.

None.

Blood culture data were used to determine whether an infection had occurred with an organism contained in an administered probiotic. Eighty-six probiotic-associated central venous catheter bloodstream infections were identified among the 23,015 patient cohort who received probiotics (0.37%). The number needed to harm was 270. Zero infections were found in the cohort that did not receive probiotics. Patients who contracted a probiotic infection had increased mortality (odds ratio, 2.23; 1.30–3.71; p < 0.01). Powder formulations had an increased rate of infection compared with nonpowder formulations (0.76% vs 0.33%; odds ratio, 2.03; 1.05–3.95; p = 0.04).

Probiotic administration is associated with a substantial rate of probiotic-associated bloodstream infection in ICU patients with central venous catheters in place. Probiotic-associated bloodstream infections result in significantly increased mortality. Powder formulations cause bloodstream infections more frequently than nonpowder formulations. In ICU patients with central venous catheters, the risks of probiotic-associated central venous catheter bloodstream infection and death outweigh any potential benefits of probiotic administration.