James M. Noel

Two cases of Lactobacillus bacteremia during probiotic treatment of short gut syndrome.

Lactobacillus, a gram-positive bacillus, is a constituent of the indigenous flora of the colon. Often used as a probiotic agent, it appears to help prevent both intestinal colonization by pathogenic organisms and bacterial overgrowth syndrome. Lactobacillus organisms in the intestine are thought to produce acetic acid, lactic acid, and hydrogen peroxide and to promote the secretion of antimicrobial substances. The production of short chain fatty acids and the resultant low luminal pH of the colon also appear to inhibit growth of bacterial pathogens (1). Lactobacillus may also compete with pathogenic organisms for mucosal surface receptors and may decrease the incidence of antibiotic-associated diarrhea and Clostridium difficile colitis (2). Although Lactobacillus generally is not considered a pathogen, it can cause disease in compromised hosts, including bacterial endocarditis, pleuropulmonary infections, gastrointestinal abscesses, urinary tract infection, conjunctivitis, dental caries, and endometritis (3). Lactobacillus bacteremia, presumably secondary to bacterial translocation from the gastrointestinal tract, has been reported in a patient with severe intestinal inflammation caused by ulcerative colitis (4). There are no published reports of bacteremia or sepsis secondary to Lactobacillus given as a probiotic agent. We report two cases of Lactobacillus GG sepsis occurring during the therapeutic use of this organism.

Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study.

OBJECTIVE To assess the relationship between bacterial enteritis and intussusception. STUDY DESIGN The Patient Administration Systems and Biostatistics Activity database from January 2002 to December 2005 was examined for clinic visits or hospital admission to a Department of Defense medical facility for children age 0-5 years. The study included the International Statistical Classification of Diseases and Related Health Problems diagnosis-related group (DRG) codes for infections with Yersinia enterocolitica, Escherichia coli, Shigella species, Salmonella species, and Campylobacter. Identified patients were then assessed for the intussusception DRG code for 0-180 days postinfection. The total number of children enrolled in military treatment facilities in the same age group (denominator) was obtained. RESULTS Bacterial enteritis significantly increased the relative risk of intussusception. An increased risk was found following infection with Salmonella, E coli, Shigella, and Campylobacter. The relative risk for intussusception following any bacterial enteritis was 40.6 (95% confidence interval = 28.6-57.5; P < .0001). CONCLUSIONS Bacterial enteritis is a significant risk factor for the subsequent development of intussusception in children.

Nutritional supplementation with transforming growth factor-β, glutamine, and short chain fatty acids minimizes methotrexate-induced injury

Objective: Gastrointestinal (GI) damage caused by methotrexate (MTX) results in mucosal injury, bacterial invasion, and activation of an immune system that is reduced in function. Diets enriched with glutamine, short chain fatty acids (SCFAs), and transforming growth factor (TGF)-β have demonstrated decreased infection, weight loss, and GI damage in Crohn disease. We, therefore, sought to study the cytoprotective effects of a diet enriched in glutamine, TGF-β, and SFCAs (Modulen) in Fischer 344 rats exposed to MTX. Methods: Rats were divided into five groups: two receiving normal saline and three receiving MTX and fed either normal chow, Modulen supplemented chow starting with the first MTX dose, or Modulen supplemented chow beginning 3 days before MTX injection. Rats were weighed daily. On day 5, albumin and bicarbonate levels were drawn, and rats were killed for examination of their intestinal mucosa by a pathologist unaware of groupings. Results: Rats pretreated with Modulen supplemented chow maintained weight (2.6 vs, 12.3 g weight loss), albumin levels (3.13 vs, 2.43 mg/dL), and bicarbonate levels (23.8 vs. 18.1 mg/dL) as compared with rats fed normal chow throughout MTX treatment (P < 0.05). Pretreatment with Modulen also protected against crypt cell loss, villus atrophy, crypt abscesses, crypt/villus ratio, and overall histologic damage (P < 0.05). Conclusion: When administered before and during MTX treatment, Modulen supplementation provided statistically significant protection against weight loss, hypoalbuminemia, acidosis, and GI damage in a rat model. Future animal research of Modulens protective effects with other chemotherapeutic agents is needed before human trials.

Lactobacillus Sepsis Associated With Probiotic Therapy

better practices associated with a reduced risk of severe ROP.3 Manzoni and colleagues raise the interesting question of how much weight should be given to data from population-based studies versus local-institution audit when discussing risks of preterm birth with parents. In many cases, the database from individual units will simply be too small to allow unbiased analysis, a factor that has been a key motivation for the growth of neonatal networks.4,5 Manzoni and colleagues reported their data by birth weight groups. As we noted in our report, significantly growth-restricted infants will be overrepresented in such groupings, and different associations may be apparent when analysis is undertaken by gestational age bands.6,7 Looking at the example of vaginal versus operative delivery cited by Manzoni et al, caesarian section (CS) with no labor showed a protective effect for severe ROP on unadjusted analysis in our data set, but it did not retain significance on multivariate analysis.1 In fact, when the effect of method of birth was adjusted for gestation alone, the effect disappeared, giving an odds ratio for CS with no labor of 1.13 (95% confidence interval: 0.76, 1.67). An additional problem with the analysis presented by Manzoni and colleagues is that they seem to be concluding an effect of mode of birth in 1 subgroup and not the other based on an inappropriate analysis. As many authors have noted, the appropriate test for performing subgroup analysis is a test of statistical interaction; it is not valid to draw this conclusion based on the fact that the P value is significant in 1 subgroup but not the other.8 However, in this example, even if a unit in the Australia and New Zealand Neonatal Network did have sufficient local institutional data to show a valid protective association with CS, although it would be reasonable to convey that information, it would also be appropriate to emphasize that overall, in Australia and New Zealand, there was no such association. We agree with Manzoni and colleagues that it is important for units to collect their own data and continually review their practices. Our study is aimed at informing and enhancing such a process for all regional neonatal units in both Australia and New Zealand. We would encourage units elsewhere to contribute data to an appropriate network.

Nosocomial bacteremia from lactobacillus supplementation in short gut syndrome: a case report

Nosocomial bacteremia from lactobacillus supplementation in short gut syndrome: a case report