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Published on: July 13, 2019
Probiotic-Associated Central Venous Catheter Bloodstream Infections Lead to Increased Mortality in the ICU
Scott Mayer1, Colin Bonhag1, Patrick Jenkins2
1HCA HealthONE, Denver, CO.
Insights
Probiotic use in ICUs with central venous catheters is linked to bloodstream infections and higher mortality. Powder probiotics pose a greater infection risk than other forms, suggesting risks outweigh benefits.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Pharmacy
Background:
- Probiotics are increasingly used in clinical settings, including intensive care units (ICUs).
- The safety of probiotic administration, particularly in vulnerable patient populations with invasive devices like central venous catheters (CVCs), requires careful evaluation.
- Potential risks, such as bloodstream infections (BSIs), need to be quantified.
Purpose of the Study:
- To determine the incidence of probiotic-associated CVC bloodstream infections (CVC-BSIs) in ICU patients.
- To assess the impact of these infections on patient outcomes, including mortality.
- To compare infection rates between different probiotic formulations.
Main Methods:
- A retrospective observational cohort study was conducted using data from HCA Healthcare's data warehouse.
- The study included adult patients with CVCs admitted to the ICU.
- Blood cultures were analyzed to identify infections caused by organisms present in administered probiotics.
Main Results:
- Eighty-six probiotic-associated CVC-BSIs occurred in 23,015 patients receiving probiotics, representing a 0.37% incidence rate (Number Needed to Harm: 270).
- Patients with probiotic BSIs had a significantly increased mortality risk (OR, 2.23; P < 0.01).
- Powder probiotic formulations were associated with a higher infection rate (0.76%) compared to non-powder formulations (0.33%; OR, 2.03; P = 0.04).
Conclusions:
- Probiotic administration is associated with a significant rate of BSI in ICU patients with CVCs.
- These infections lead to substantially increased mortality.
- The risks associated with probiotic-associated CVC-BSIs, especially with powder formulations, appear to outweigh potential benefits in this patient population.
Objectives:
To determine the occurrence rate and impact on patient outcomes of probiotic-associated central venous catheter bloodstream infections in the ICU.
Design:
Retrospective observational cohort study.
Setting:
The cohort was gathered using HCA Healthcare's data warehouse.
Patients:
Adult patients with central venous catheters in the ICU.
Interventions:
None.
Measurements And Main Results:
Blood culture data were used to determine whether an infection had occurred with an organism contained in an administered probiotic. Eighty-six probiotic-associated central venous catheter bloodstream infections were identified among the 23,015 patient cohort who received probiotics (0.37%). The number needed to harm was 270. Zero infections were found in the cohort that did not receive probiotics. Patients who contracted a probiotic infection had increased mortality (odds ratio, 2.23; 1.30-3.71; p < 0.01). Powder formulations had an increased rate of infection compared with nonpowder formulations (0.76% vs 0.33%; odds ratio, 2.03; 1.05-3.95; p = 0.04).
Conclusions:
Probiotic administration is associated with a substantial rate of probiotic-associated bloodstream infection in ICU patients with central venous catheters in place. Probiotic-associated bloodstream infections result in significantly increased mortality. Powder formulations cause bloodstream infections more frequently than nonpowder formulations. In ICU patients with central venous catheters, the risks of probiotic-associated central venous catheter bloodstream infection and death outweigh any potential benefits of probiotic administration.
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