Friday, January 11, 2019

Are Infectious Complications Following Probiotics an Underestimated Problem?

Probiotics seem to be everywhere. From dietary supplements to chocolate bars, these products are designed to improve one’s microbiome. Yet, there have been few serious evaluations of complications related to probiotic ingestion. This study presents a synthesis and critical evaluation of the reports and series of cases on the infectious complications related to the ingestion of probiotics, which can raise awareness for the prescribing and use of probiotics for certain groups of patients. The researchers emphasize that this study is not meant to discourage the use of probiotics, but to instead better understand that certain high-risk patients may not benefit from the introduction of probiotics in a clinical setting.

In this study, published in BMC Complementary and Alternative Medicine, researchers culled and systematically reviewed the data from PubMed, SciELO and Scopus databases published until August 2018. They found 60 case reports and 7 case series, making up a total of 93 patients. Among those studies, they found certain strains of probiotics were responsible for the most complications. They also found common factors associated with mortality, including infants and the elderly with compromised immunity and the prevalence of C. dificile, colitis and antibiotic use.

The authors note “to assume that probiotic intake is completely risk-free is not true. The proportion of cases of infectious complications is small when the total number of people who use probiotics is considered. However, the cases described here are infections with high mortality rates such as endocarditis and sepsis. So, although on one hand there is the possibility of publication bias, with more serious cases having been published, on the other, due to the mentioned limitation for the publication of case reports, several other serious cases may not have reached public knowledge.”

The use of probiotics cannot be considered risk-free and should be carefully evaluated for some patient groups. The most frequent probiotic-related infectious complications were fungemia and sepsis and the most frequent probiotic microorganisms were of the genus Saccharomyces, a fungus. Mortality was associated with age > 60 years, C. dificile colitis, current antimicrobial use and Saccharomyces infection. Probiotics were often used in the context of excessive antibiotic use, and a more judicious use of antibiotics is critical, as the use of probiotics cannot be considered risk free and should be carefully evaluated for high-risk groups of patients.

My Take:
Again, I removed much of the technical jargon. Saccharomyces is commonly used as a probiotic and should be avoided unless the patient has been diagnosed with C. dificile.

I have been preaching caution with the use of probiotics for years. This study only looked at cases of serious illness, like HIV/AIDS, but should give you cause for concern, especially if you are taking a probiotic daily.

Bottom Line:
Probiotics should be used sparingly. Specific, short term use is warranted following antibiotic therapy, chemotherapy, and/or radiation therapy. About two weeks of daily use should suffice.

However, if you were not born through vaginal delivery, then you missed out on your initial inoculation of probiotics from your mother. No amount of probiotic supplementation will restore your gut to normal, but ongoing probiotic therapy may well be of value. The question then becomes what probiotic should you take? There is no clear answer to that question as we are all unique in our microbiota.

Source: December 18, 2018 Today’s Practitioner

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