Incidence of Saccharomyces cerevisiae Fungemia in Hospitalized Patients Administered Saccharomyces boulardii Probiotic.

Abstract

BACKGROUND\nBloodstream 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.\n\n\nMETHODS\nRetrospective observational analysis of incident Saccharomyces cerevisiae fungemia in a population of hospitalized patients administered Saccharomyces boulardii for primary prevention of hospital-onset Clostridioides difficile infection. Adult patients admitted to an inpatient medical unit for 48-hours or more between January 1, 2016 and December 31, 2019 are included. Facility medication administration records and microbiology records were evaluated for S. boulardii probiotic administration and incidence of S. cerevisiae positive blood cultures. Microbiologic identification methods were unable to distinguish S. cerevisiae from S. boulardii.\n\n\nRESULTS\nAdministration of S. boulardii probiotic occurred in 16,404 of 46,729 patients analyzed. S. cerevisiae fungemia was identified in 18 probiotic recipients (0.11%). The observed incidence of fungemia attributable to S. boulardii administration is 1.70 cases per 10,000 patient-days. Central-line days numbered 52,949 yielding an incidence of 0.26 cases of S. cerevisiae per 1,000 central-line days. Intensive care unit admission was significantly associated with an increase in the risk of S. cerevisiae (OR 6.55, CI 2.28 - 18.87), incidence rate of 0.47 cases per 1,000 patient-days.\n\n\nCONCLUSION\nRisk of bloodstream infection as a result of S. boulardii probiotic use appears restricted to S. boulardii recipients. 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.