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Invasive Infections Associated with the Use of Probiotics in Children: A Systematic Review
Martina D'Agostin1, Domenica Squillaci1, Marzia Lazzerini2
1Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy.
Insights
Probiotics are widely used in children despite safety concerns. This review found invasive infections linked to probiotics, particularly in infants, highlighting the need for further safety research.
Area of Science:
- Microbiology
- Pediatrics
- Infectious Diseases
Background:
- Probiotics are widely administered to children, perceived as safe, despite evidence of effectiveness only in specific conditions.
- Emerging concerns highlight potential risks, including severe opportunistic infections, especially in pediatric populations.
Purpose of the Study:
- To systematically review and summarize case reports of invasive infections associated with probiotic use in children.
- To identify the types of probiotics implicated and the clinical characteristics of affected pediatric patients.
Main Methods:
- A comprehensive literature search was conducted across three electronic databases.
- Case reports detailing probiotic-derived invasive infections in pediatric patients were identified without language restrictions.
- Data from 49 case reports published between 1995 and June 2021 were analyzed.
Main Results:
- Infections were attributed to various probiotic species, including Lactobacillus (35%), Saccharomyces (29%), and Bifidobacterium (31%).
- The majority of affected patients (80%) were under two years old, with sepsis being the most common diagnosis (69.4%).
- Underlying conditions like prematurity (55%) and intravenous catheter use (51%) were frequent predisposing factors; 6% of children died.
Conclusions:
- Probiotic use in children, despite its widespread nature, is associated with a risk of severe invasive infections.
- Infants, particularly those with predisposing conditions, are most vulnerable.
- Further research is crucial to determine the actual incidence of probiotic-associated systemic infections.
Abstract:
Although the effectiveness of probiotics has only been proven in specific conditions, their use in children is massively widespread because of their perception as harmless products. Recent evidence raises concerns about probiotics' safety, especially but not only in the paediatric population due to severe opportunistic infections after their use. This review aimed at summarising available case reports on invasive infections related to probiotics' use in children. For this purpose, we assessed three electronic databases to identify papers describing paediatric patients with documented probiotic-derived invasive infections, with no language restrictions. A total of 49 case reports from 1995 to June 2021 were identified. The infections were caused by Lactobacillus spp. (35%), Saccharomyces spp. (29%), Bifidobacterium spp. (31%), Bacillus clausii (4%), and Escherichia coli (2%). Most (80%) patients were younger than 2 years old and sepsis was the most observed condition (69.4%). All the patients except one had at least one condition facilitating the development of invasive infection, with prematurity (55%) and intravenous catheter use (51%) being the most frequent. Three (6%) children died. Given the large use of probiotics, further studies aiming at evaluating the real incidence of probiotic-associated systemic infections are warranted.
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