Catheter-related bacteremia due to Lactobacillus rhamnosus in a single-lung transplant recipient

Catheter-related bloodstream infection caused by Lacticaseibacillus paracasei: A case report and literature review

Catheter-related bloodstream infections (CRBSIs) caused by Lactobacillus spp. and Lacticaseibacillus spp. are rare, and their clinical course and optimal treatment remain uncertain. In this report, we present a 46-year-old male patient who experienced clinically diagnosed Lacticaseibacillus paracasei CRBSI on four separate occasions, despite receiving systemic administration of antibiotics and antimicrobial lock therapy. The patient did not develop L. paracasei bacteremia after catheter removal. This case report furthers our knowledge of CRBSI caused by Lactobacillus and related genera and highlights the need for further research.

Bacteraemia caused by Lactobacillus casei in a patient after cardiac surgery. A case report

BACKGROUND

Bacteria of the Lactobacillus family are a part of the physiological flora of the oral cavity, gastrointestinal tract, and urinary tract. We have used them in the food industry as probiotics and supplements. In some settings, rod-shaped lactic acid bacteria may become pathogenic. It may occur in immunocompromised or heart disease patients after cardiac surgery, patients with disturbed intestinal wall permeability, or those treated with broad-spectrum antibiotics.

CASE PRESENTATION

We present rare bacteraemia induced by the probiotic bacterium Lactobacillus casei in a 63-year-old patient after the attempted removal of ICD electrodes, complicated by acute regurgitation of the tricuspid valve. The patient underwent urgent cardiac surgery, the electrode elements were removed, and the tricuspid valve was replaced with a biological prosthesis. After surgery, the patient required intensive, multidisciplinary treatment with mechanical ventilation, continuous renal replacement therapy, broad-spectrum empirical antibiotic therapy, parenteral nutrition, and blood product transfusion because of multiple organ failure. On the 14th day of hospitalisation, the clinical symptoms of septic shock were observed. The microbiological investigation was performed, and Lactobacillus casei was cultured from a dialysis catheter sample. Dedicated antimicrobials were administered, and the patient was discharged home in good overall condition.

CONCLUSIONS

The present case shows that the promoted use of probiotics must be cautiously administered to patients in severe conditions, especially when accompanied by reduced immune system efficiency symptoms.

Bacteraemia Caused by Probiotic Strains of Lacticaseibacillus rhamnosus—Case Studies Highlighting the Need for Careful Thought before Using Microbes for Health Benefits

Lactic acid bacteria belonging to Lactobacillus spp. and Lacticaseibacillus spp. are a natural part of fermented milk and other food products, probiotic supplements and human microbiota. They mainly belong to mucosal microflora, especially oral, vaginal and intestinal. Lacticaseibacillus spp. strains included in probiotics are generally characterised as safe microorganisms, and the species are concerned bacteria with very low pathogenic potential. However, infections caused by Lactobacillus spp. and Lacticaseibacillus spp., including bacteraemia and endocarditis, occur occasionally. The aim of the study was to present two cases of bacteraemia due to Lacticaseibacillus rhamnosus associated with the use of a probiotic product. It afflicted patients in intensive care units. The investigation was preliminarily based on clinical and microbiological recognition of the cases. The initial observation was laboratory confirmed with the application of pulsed-field gel electrophoresis (PFGE) results. Identical PFGE patterns were obtained for the evaluated strains and the strains derived from a commercially available probiotic that was administered to those patients. The increasing number of studies describing opportunistic infections due to probiotic strains of Lacticaseibacillus spp. should result in verifying the safety of probiotic formulations used in immunocompromised patients and forming detailed guidelines for the use of probiotics among patients from several risk groups.

Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute

In Germany, guidelines for hygiene in hospitals are given in form of recommendations by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, "KRINKO"). The KRINKO and its voluntary work are legitimized by the mandate according to § 23 of the Infection Protection Act (Infektionsschutzgesetz, "IfSG"). The original German version of this document was published in February 2021 and has now been made available to the international professional public in English. The guideline provides recommendations on infection prevention and control for immunocompromised individuals in health care facilities. This recommendation addresses not only measures related to direct medical care of immunocompromised patients, but also management aspects such as surveillance, screening, antibiotic stewardship, and technical/structural aspects such as patient rooms, air quality, and special measures during renovations.

The Role of Probiotics, Prebiotics and Synbiotics in Combating Multidrug-Resistant Organisms

The prevalence of multidrug-resistant organisms is increasing worldwide, posing a unique challenge to global health care systems. Novel approaches are needed to combat the spread of infection with these organisms. The enteric microbiome, and in particular the resistome, offers a unique target in both the prevention of infection with these organisms and the acquisition and spread within the community. We highlight a novel approach to combat multidrug-resistant organisms: the use of prebiotics, probiotics, and synbiotics to manipulate the microbiome and resistome. This review summarizes the published literature and clinical trials related to these products to date, with a focus on efficacious trials. It highlights the probable mechanism of action for each product, as well as its safety profile in selective populations. Ultimately, although further research is needed before a definitive statement can be made on the efficacy of any of these 3 interventions, the literature to date offers new hope and a new tool in the arsenal in the fight against bacterial drug resistance.

Recurrent Lactobacillus Bacteremia in a Patient With Leukemia

Lactobacillus species are a commensal flora of the human gastrointestinal and the female genitourinary tract. Lactobacilli especially the rhamnosus species, are common components of commercial probiotics. They are rarely associated with pathology in immunocompetent people, but they have been known to cause dental caries, bacteremia, and endocarditis in patients with suppressed immune function. Cases of Lactobacillus bacteremia have been reported in patients with acute myeloid leukemia, large granular lymphocytic leukemia, and in transplant recipients. In this article, we report a strange case of recurrent Lactobacillus bacteremia causing multiple episodes of fever of unknown origin in a patient with leukemia. This report is unique as Lactobacillus is not recognized as a common source of bacteremia. Moreover, the source of the bacillus continued to elude us even after extensive investigation.

Mechanisms and therapeutic effectiveness of lactobacilli

The gut microbiome is not a silent ecosystem but exerts several physiological and immunological functions. For many decades, lactobacilli have been used as an effective therapy for treatment of several pathological conditions displaying an overall positive safety profile. This review summarises the mechanisms and clinical evidence supporting therapeutic efficacy of lactobacilli. We searched Pubmed/Medline using the keyword ‘Lactobacillus’. Selected papers from 1950 to 2015 were chosen on the basis of their content. Relevant clinical and experimental articles using lactobacilli as therapeutic agents have been included. Applications of lactobacilli include kidney support for renal insufficiency, pancreas health, management of metabolic imbalance, and cancer treatment and prevention. In vitro and in vivo investigations have shown that prolonged lactobacilli administration induces qualitative and quantitative modifications in the human gastrointestinal microbial ecosystem with encouraging perspectives in counteracting pathology-associated physiological and immunological changes. Few studies have highlighted the risk of translocation with subsequent sepsis and bacteraemia following probiotic administration but there is still a lack of investigations on the dose effect of these compounds. Great care is thus required in the choice of the proper Lactobacillus species, their genetic stability and the translocation risk, mainly related to inflammatory disease-induced gut mucosa enhanced permeability. Finally, we need to determine the adequate amount of bacteria to be delivered in order to achieve the best clinical efficacy decreasing the risk of side effects.

Lactobacillus rhamnosus bacteremia: an emerging clinical entity

Lactobacillus spp. are ubiquitous commensals of the normal human flora that are only occasionally found in clinical infections. Their role in human disease is established for infectious endocarditis but is controversial for other infections. We sought to characterize clinically associated Lactobacillus spp. We conducted a retrospective study, which consisted of the screening of Lactobacillus isolates obtained in our laboratory from January 2004 to December 2009. The polymerase chain reaction (PCR) assay was selected as the gold standard method. The isolates were first identified using API Coryne strips, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and 16S rRNA gene sequencing. Lactobacillus tuf gene-based identification was used when the 16S rRNA results were inconclusive. Among the 60 strains of Lactobacillus spp. obtained in our laboratory, L. rhamnosus was the most commonly isolated species and was found in blood cultures from 16 patients. Combined with 45 patients reported in the literature, we found that patients presenting with L. rhamnosus bacteremia experienced nosocomial infections associated with both immunosuppression (66 %) and catheters (83 %).

Lung abscess and pleuritis caused by Lactobacillus rhamnosus in an immunocompetent patient

A 79-year-old man consulted us because of left chest pain and fever ranging from 38.0 to 38.9 °C. A chest computed tomography scan showed a mass lesion (φ40 mm) in the left lingular segment, and inflammatory markers were elevated. He was admitted with a diagnosis of lung abscess, and panipenem/betamipron was administered at a dose of 2 g/day, after which the symptoms showed slight transient resolution. However, his body temperature increased again, to more than 39.0 °C, on the eighth day of hospitalization, and a chest radiograph suggested pleuritis as a complication. The antibiotics were changed to teicoplanin (TEIC; 400 mg/day) and meropenem (2.0 g/day). Thoracic drainage and pleural lavage were initiated at the same time. Lactobacillus spp. was detected from the pleural effusion by culture and was considered to be the causative organism, and it was resistant to TEIC. Therefore, the antibiotic was changed, to clindamycin, to which the bacteria was susceptible. No subsequent fever or pleural fluid retention was observed. The patient’s course was good, and he was discharged on day 45 of hospitalization. Subsequently, the causative organism was identified as Lactobacillus rhamnosus by the 16s rRNA sequence. Lactobacillus rhamnosus is rarely pathogenic in humans. Lactobacillus rhamnosus infection mostly occurs in immunosuppressed patients, and only a few cases have been reported in immunocompetent patients. In the present case, the patient was not immunodeficient; however, his lung had an impaired local immunosystem, due to emphysema.

Prognostic factors and impact of antibiotherapy in 117 cases of anaerobic bacteraemia

Bacteraemia due to anaerobic bacteria occurs infrequently, making the systematic use of an anaerobic blood sample bottle in patients with sepsis controversial. We retrospectively reviewed the clinical and microbiological data from all cases of anaerobic bacteraemia in a teaching hospital over 2 years and determined the prognostic factors and antibiotic management. With the goal of evaluating the morbidity and mortality of bacteraemia due to anaerobic bacteria, a case-control study was also performed. One hundred eighty-four blood cultures from 125 patients grew at least one anaerobic bacterium, representing 0.5% of all and 7.0% of the positive blood cultures. One hundred seventeen patients were studied. In 24 cases, anaerobic blood cultures were associated with concomitant aerobic bacteria isolation. The most frequently isolated anaerobic species were Bacteroides sp. (n = 62), Clostridium sp. (n = 25), and Fusobacterium sp. (n = 12). The most frequent site of origin was the digestive tract (n = 61). In 51 cases, patients did not receive adequate empirical antianaerobic therapy. The mortality rate was 27%. Age [odds ratio (OR) 1.059; 95% confidence interval (CI) 1.021-1.100], cancer history (OR 3.21, 95% CI 1.126-9.156), and ineffective definitive antibiotherapy (OR 19.292, 95% CI 5.330-69.832) were independently associated with increased hospital mortality. The 72 patients that could be matched with patients without anaerobic bacteria according to their primary diagnosis had a longer hospitalisation and a trend toward increased mortality (P = 0.08). Anaerobic bacteraemia contributed significantly to the morbidity of the patients, and adequate empirical antibiotherapy may play an important role in the clinical outcomes.

Intraspecific genotypic characterization of Lactobacillus rhamnosus strains intended for probiotic use and isolates of human origin

A set of 118 strains of the species Lactobacillus rhamnosus was collected, including probiotic strains, research strains with potential probiotic properties, food starter cultures, and human isolates. The majority of the strains were collected from companies, hospitals, or culture collections or were obtained after contacting authors who reported clinical case studies in the literature. The present work aimed to reveal the genotypic relationships between strains of these diverse sources. All strains were initially investigated using fluorescent amplified fragment length polymorphism (FAFLP) with three different primer combinations. Numerical analysis of FAFLP data allowed (i) confirmation of the identification of all strains as members of L. rhamnosus and (ii) delineation of seven stable intraspecific FAFLP clusters. Most of these clusters contained both (potentially) probiotic strains and isolates of human origin. For each of the clusters, strains of different sources were selected for pulsed-field gel electrophoresis (PFGE) of macrorestriction fragments obtained with the enzymes NotI and AscI. Analysis of PFGE data indicated that (i) some (potentially) probiotic strains were indistinguishable from other probiotic strains, suggesting that several companies may use duplicate cultures of the same probiotic strain, and (ii) in a number of cases human isolates from sterile body sites were indistinguishable from a particular probiotic strain, suggesting that some of these isolates may be reisolations of commercial strains.

Probiotic lactobacilli and bacteraemia in Stockholm

The objective of the present study was to determine the incidence of lactobacilli-induced bacteraemia in Stockholm, Sweden, between January 1998 and March 2004, and to identify the possible presence of probiotic strains. Isolated strains were checked for growth on selective lactobacilli-agar and the biochemical profiles were determined. The lactobacilli strains were further analysed with molecular methodologies to ascertain eventual similarities with the probiotic strains Lactobacillus paracasei subsp. paracasei F19 (LMG P 17806), Lactobacillus acidophilus NCFB 1748 and Lactobacillus rhamnosus GG (ATCC 53103). The minimum inhibitory concentrations of selected antimicrobial agents were determined by the agar dilution method. The incidence of bacteraemia cases caused by lactobacilli remained at the same level during the study period and constituted to <1% of the total number of bacteraemia cases each y. L. paracasei subsp. paracasei F19, L. acidophilus NCFB 1748 and L. rhamnosus GG were not identified in any of the samples.

Pathogenic relevance of Lactobacillus: a retrospective review of over 200 cases

Given that Lactobacillus has been reported to be the causative pathogen in many types of infection despite debate regarding the organism's clinical significance, a literature review was conducted to investigate the treatments and outcomes of Lactobacillus infections reported to date. In this article, the characteristics of over 200 reported cases of Lactobacillus-associated infections are summarized. Lactobacillus was found to be frequently associated with endocarditis and bacteremia. Lactobacillus was also associated with a variety of other infections including, but not limited to, peritonitis, abscesses, and meningitis. The species casei and rhamnosus were the most common. The isolates tended to be most sensitive to erythromycin and clindamycin and most resistant to vancomycin. The species that was most sensitive to vancomycin was acidophilus. The overall mortality rate was nearly 30%. There was a significant association between mortality and polymicrobial infection (P=0.004). In the subset of patients with bacteremia, increased mortality was associated with inadequate treatment (P=0.001) and polymicrobial bacteremia (P=0.044).

Lactobacilli – bacteria–host interactions with special regard to the urogenital tract

Lactobacilli are part of the commensal human mucosal flora. Their application as probiotics in dairy products such as yoghurt has increased during the last century since a health promoting effect has been reported. Much work has been done to study the effects of these bacteria on the immune system and epithelial cells, mainly focused on the intestinal mucosa as the field of first contact. This review is aimed to present and discuss results concerning interactions of lactobacilli and immune system or epithelial cells with focus to urogenital mucosa.