A case of yogurt central line-associated bloodstream infection in a child with intestinal failure

Central line-associated bloodstream infections (CLABSI) are a significant cause of morbidity in children with intestinal failure (IF). Probiotic therapy is discouraged in patients with IF because of the increased risk of bacteremia with the probiotic organism. We report an unusual, previously undescribed, clinical presentation of a Lactobacillus-species CLABSI linked to yogurt consumption in a toddler with IF secondary to Megacystis-microcolon-intestinal hypoperistalsis syndrome. Lactobacillus is abundant in fermented foods like yogurt and among the commensal constituents of the oral cavity microbiome and mucosal surfaces in the gastrointestinal tract. It is rarely implicated as the causative organism in CLABSI. At the time of presentation with fever, blood cultures were collected from the patient's central venous catheter (CVC), and peripherally. Both grew Lactobacillus species. Comparative genetic analysis predicted ~99% similarity between the CLABSI isolate and Lactobacillus isolates from the Greek yogurt the patient regularly consumed. Our patient's Lactobacillus CLABSI was linked to the consumption of Greek yogurt. We speculate that daily consumption of yogurt with live cultures posed a high cumulative exposure to Lactobacillus species either through external contamination of our patient's CVC or translocation of the ingested organisms from his gastrointestinal tract into the bloodstream. This is the first case report that links CLABSI in children with IF to yogurt consumption.