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Probiotic use and prevalence of candidemia and candiduria in a PICU

Suresh Kumar1, Sunit Singhi, Arunloke Chakrabarti

  • 11Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|August 23, 2013
PubMed

Insights

Routine probiotic use in pediatric intensive care units (PICUs) significantly reduced the prevalence of candidemia and candiduria in children receiving broad-spectrum antibiotics. This intervention offers a promising strategy for infection control in vulnerable pediatric populations.

Area of Science:

  • Pediatric critical care medicine
  • Infectious diseases
  • Microbiology

Background:

  • Broad-spectrum antibiotics in pediatric intensive care units (PICUs) disrupt the gut microbiota, increasing the risk of fungal infections like candidemia and candiduria.
  • Candida species are common causes of nosocomial infections in critically ill children, associated with significant morbidity and mortality.

Purpose of the Study:

  • To evaluate the impact of routine probiotic supplementation on the incidence of candidemia and candiduria in pediatric patients receiving broad-spectrum antibiotics.
  • To compare fungal infection rates before and after the implementation of a probiotic intervention in a PICU setting.

Main Methods:

  • A retrospective
  • before and after
  • study design was employed in a 12-bed PICU in India.
  • The study included children aged 3 months to 12 years who received broad-spectrum antibiotics for over 48 hours.
  • Data were collected from a control group (n=376) and a probiotic group (n=344) receiving a specific probiotic mix.

Main Results:

  • The probiotic group showed a significantly lower prevalence of candidemia (1.2% vs. 3.7%; p=0.03) and candiduria (10.7% vs. 22%; p=0.0001) compared to the control group.
  • Relative risk for candidemia was 0.31 (95% CI, 0.10-0.94) and for candiduria was 0.48 (95% CI, 0.34-0.7) in the probiotic group.
  • Trends towards lower rates of nosocomial bloodstream infections and urinary tract infections were observed in the probiotic group, though not statistically significant (p=0.07 and p=0.08, respectively).

Conclusions:

  • Routine administration of a probiotic mix can be an effective strategy to decrease the incidence of candidemia and candiduria in pediatric patients on broad-spectrum antibiotics.
  • Probiotics may play a role in preventing fungal colonization and subsequent invasive infections in the critically ill pediatric population.
  • Further research is warranted to confirm these findings and explore the optimal probiotic formulations and durations for infection prevention in PICUs.
Abstract

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