Lactobacillus Sepsis following a Laparotomy in a Preterm Infant: A Note of Caution

Area of Science:

• Neonatal Medicine
• Microbiology
• Surgical Outcomes

Background:

• Probiotics are increasingly used in preterm infants, with meta-analyses suggesting benefits like reduced necrotizing enterocolitis and mortality.
• However, the applicability of these findings to specific subgroups, such as very low birth weight infants (<1,000 g), remains debated.
• The role of probiotics in preterm and term infants undergoing intestinal surgery is not well-established.

Observation:

• A case of late-onset sepsis caused by Lactobacillus rhamnosus in a premature infant following a laparotomy is presented.
• This observation suggests a potential link between probiotic administration and serious infection in this context.
• A review of relevant published cases was conducted to contextualize this event.

Findings:

• Preterm infants, particularly those with a history of intestinal surgery, may be at an elevated risk for systemic probiotic-related infections.
• Lactobacillus rhamnosus, a common probiotic, was identified as the causative agent in the reported sepsis case.
• Existing literature may not fully capture the risks associated with probiotics in surgically treated preterm neonates.

Implications:

• Clinical guidelines for probiotic use in preterm infants, especially those with gastrointestinal issues or post-surgery, require careful consideration and potential revision.
• Healthcare providers should maintain a high index of suspicion for probiotic-associated infections in preterm infants, particularly after abdominal surgery.
• Further research is warranted to define the safety and efficacy of probiotics in specific high-risk neonatal subgroups, including those with surgical histories.