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Published on: January 27, 2019
Lactobacillus rhamnosus sepsis associated with probiotic therapy in an extremely preterm infant: Pathogenesis and a
Ming-Chou Chiang1, Chyi-Liang Chen2, Ye Feng3
1Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Insights
Probiotic Lactobacillus rhamnosus GG can cause sepsis in preterm infants, particularly catheter-related infections. Biofilm formation by this probiotic strain is a critical factor in developing sepsis, especially with glucose presence.
Area of Science:
- Neonatal Medicine
- Microbiology
- Infectious Diseases
Background:
- Necrotizing enterocolitis (NEC) is a severe complication in preterm infants.
- Probiotics, like Lactobacillus rhamnosus GG (L. rhamnosus GG), are used to prevent NEC.
- Safety concerns exist regarding probiotic use in preterm infants.
Observation:
- A preterm infant receiving oral L. rhamnosus GG developed sepsis.
- Blood and catheter tip cultures identified L. rhamnosus.
- Genome sequencing confirmed isolates as L. rhamnosus GG (ATCC 53103), indicating a probiotic-related infection.
Findings:
- The patient recovered after antibiotic treatment.
- L. rhamnosus GG isolates demonstrated biofilm formation capabilities.
- Biofilm formation was influenced by environmental factors and culture media.
- A literature review revealed ~60% of L. rhamnosus GG sepsis cases in infants involved infected catheters.
Implications:
- L. rhamnosus GG's biofilm-forming capacity is a critical factor in probiotic-related sepsis in preterm infants.
- This highlights the need for careful safety monitoring of probiotics in vulnerable infant populations.
- Understanding biofilm formation mechanisms is crucial for preventing probiotic-associated infections.
Background:
Necrotizing enterocolitis (NEC) is one of the most serious complications in preterm infants. Probiotics have been used to prevent NEC. Safety is a major concern for this practice.
Methods:
We reported a female preterm infant who received oral Lactobacillus rhamnosus GG but developed sepsis 12 days after the treatment. Cultures of blood and the catheter tip yielded L. rhamnosus. Next-generation sequencing was performed to analyze isolates from blood, stool, catheter, and product capsules. We also determined the capacities of these isolates to form biofilms. A literature review was performed.
Results:
The patient was treated with ampicillin and piperacillin/tazobactam, and she subsequently recovered without complications. The analysis of genome sequences indicated that all the isolates belonged to the clone of L. rhamnosus GG (ATCC 53103), suggesting that sepsis was a catheter-related infection caused by the oral probiotic. L. rhamnosus GG (ATCC 53103) and the probiotic strain tested formed biofilms under all growth conditions. Isolates from the blood and catheter tip also formed biofilms, but the stool isolate did not. The capacity of intrinsic biofilm formation in L. rhamnosus GG depended on environmental factors and the type of culture medium. Literature review of L. rhamnosus GG sepsis in preterm and young infants found that nearly 60% of the patients had a suspected or confirmed infected catheter.
Conclusion:
The study showed that the capacity of L. rhamnosus GG to form biofilms, especially in the presence of glucose, is a critical factor leading to the probiotic-related sepsis in preterm infants.
