Methods: A case-control study was performed on ICU patients receiving Lactobacillus GG at Boston Children’s Hospital from January 2009 through June 2014. Every case of Lactobacillus bacteremia was matched to up to 3 randomly-selected controls who did not have bacteremia but had received Lactobacillus within 90 days of the date of bacteremia in the matched case and who had an equal or higher number of ICU days prior to censorship. Cases were censored at day of bacteremia and controls at day of ICU discharge. Potential risk factors were assessed during the 7-day period prior to censorship and summarized using descriptive statistics and 95% confidence intervals.
Results: During the study period, 661 ICU patients received 16,298 doses of Lactobacillus. There were six cases of Lactobacillus bacteremia, which were matched to 16 eligible controls. Cases were older than controls (8.8 years [95% CI 1.6,18.3] vs. 2.6 years [95% CI 2.2,10.8]) and a higher proportion were male (100% vs. 50%). No patients in either group had oncologic diagnoses, history of transplantation, or underlying gastrointestinal disorder. A smaller proportion of case patients had cardiovascular disorders (17%) compared to controls (56%). During the seven days prior to bacteremia, case patients received 15.2 days of therapy (95% CI 2.8,27.6) compared with 8.2 days of therapy (95% CI 6.0,10.3). Similar proportions of cases and controls had a central venous catheter (CVC) (83% vs. 81%), and median number of CVC days was 26 for cases and 28 for controls. Higher proportions of case patients compared with controls had a urinary catheter (33% vs. 6%), ventilator dependence (50% vs. 25%), gastrostomy tube (83% vs. 69%), and recent surgery (17% vs. 6%).
Conclusion: Despite the frequent administration of probiotics in pediatric intensive care units, the incidence of Lactobacillus bacteremia in patients receiving probiotics is low. Multicenter studies will be needed to further define risk factors in this population.
K. B. Flett,
G. P. Priebe, None
T. J. Sandora, None