Bloodstream infection by Saccharomyces cerevisiae in a COVID-19 patient receiving probiotic supplementation in the ICU in Brazil

Abstract

Care-related infections (CRIs) have a negative impact on the morbidity and mortality of patients in intensive care. Among them, fungal infections (e.g. Candida spp. and Aspergillus spp.) have high mortality in critically ill patients, particularly those with acute respiratory distress syndrome (ARDS) and immunosuppression. Coronavirus disease 2019 (COVID-19) causes severe respiratory changes and deregulation of the immune system. Here, we describe a case of fungal infection in an intensive care unit (ICU) patient with COVID-19 caused by Saccharomyces cerevisiae, a yeast widely used in the baking and wine production industries. It is also used as a probiotic, both for prevention and as adjunctive therapy in patients with diarrhoea. The patient was admitted to the ICU with a diagnosis of COVID-19, respiratory failure, complications of ARDS and renal failure, and was being treated with antibiotics and vasoactive amines. Later, the patient had diarrhoea and, after supplementation with Saccharomyces, he developed a bloodstream infection with Saccharomyces. The patient died after 61 days of hospitalization due to thrombocytopenia and bleeding. This case report suggests avoiding the use of probiotics in intensive care patients under the administration of antibiotics and amines, and with damage to the intestinal mucosa and immunodeficiency caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), since these factors could favour the translocation of fungi.

Digoxin Derivatives Sensitize a Saccharomyces cerevisiae Mutant Strain to Fluconazole by Inhibiting Pdr5p

“…Saccharomyces cerevisiae is a yeast that is widely employed as a model organism in biochemistry and microbiology, since it is non-pathogenic and easily manipulated at the genetic level [ 12 ]. Considering the study of antimicrobial resistance, using S. cerevisiae as a tool is interesting because this yeast expresses transporters related to the MDR phenotype, such as Pdr5p, Pdr10p, Pdr11p, Pdr12p, Pdr15p, Pdr18p, Ycf1p, Snq2p, and Yor1p [ 8 ]. Pdr5p is the most studied of these transporters, due to its high promiscuity [ 21 ] and homology with efflux transporters found in pathogenic fungi, such as Candida spp.…”

“…Saccharomyces cerevisiae is a ubiquitous yeast, and is considered to be non-pathogenic. Nonetheless, some studies have reported bloodstream infections caused by this microorganism [ 8 , 9 ]. Moreover, S. cerevisiae possesses several MDR proteins, and Pdr5p is currently the best studied of them [ 10 ].…”

Update of the list of QPS‐recommended microbiological agents intentionally added to food or feed as notified to EFSA 16: suitability of taxonomic units notified to EFSA until March 2022

“…Four of them published fungaemia cases linked to the use of S. boulardii as a probiotic. Pinto et al., ( 2021 ) described a case of a fungal infection caused by S. cerevisiae in a critically ill COVID‐19 patient in an intensive care unit (ICU) after supplementation with Saccharomyces . Rannikko et al.…”

Probiotic Supplementation Prevents the Development of Ventilator-Associated Pneumonia for Mechanically Ventilated ICU Patients: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

“…Our previous network meta-analysis (NMA) on NI in critically ill patients suggested that TPN and EPN supplemented with or without probiotic, prebiotic, and synbiotic therapies did not significantly prevent the incidence of VAP (59). Moreover, evidence has highlighted the higher risk of bacterial and fungal translocation resulting from synbiotic and probiotic therapies in critical patients with damaged intestinal mucosa and immunodeficiency (60)(61)(62). These patients even showed an increased risk of mortality (63).…”