Fungemia Due to<i>Saccharomyces</i>Species in a Patient Treated with Enteral<i>Saccharomyces boulardii</i>

Niault, Mathilde; Thomas, Frank; Prost, J; Ansari, F H; Kalfon, Pierre

doi:10.1086/517255

Cited by 60 publications

(26 citation statements)

References 2 publications

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“…Moreover, these are live organisms and they should be used cautiously, if at all, in individuals with signifi cant immune suppression because of the possible risk of bacteremia or fungemia. Th ere are cases of S. boulardii fungemia reported in patients with central venous catheters, and thus its use in an ICU or in immunocompromised patients is not recommended ( 113,114 ). Th ere are also numerous case reports of invasive lactobacillus infections in non-immunosuppressed (mostly elderly) patients ( 115 -117 ).…”

Section: Management Of CDI and Co-morbid Conditionsmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,468

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Section: Management Of CDI and Co-morbid Conditionsmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,468

1,408

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“…Fungemia caused by S. cerevisiae subtype boulardii should not be considered rare. To our knowledge, 24 well-described clinical cases have been reported in the literature (1,3,4,6,7,9,10,(13)(14)(15)(16) (Table 1). In a further report, 12 (93%) of 13 S. cerevisiae blood isolates collected in five hospitals over a 2-year period were retrospectively subtyped as S. cerevisiae subtype boulardii, and their etiologic role in fungemias was demonstrated by a genotypic comparison with commercial preparations labeled S. boulardii (12).…”

Section: Case 4 (Incomplete Report)mentioning

confidence: 99%

Outbreak of Saccharomyces cerevisiae Subtype boulardii Fungemia in Patients Neighboring Those Treated with a Probiotic Preparation of the Organism

et al. 2003

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We report an outbreak of Saccharomyces cerevisiae subtype boulardii fungemia among three intensive care unit roommates of patients receiving lyophilized preparations of this fungus. The fungemia was probably due to central venous catheter contamination and resolved after fluconazole treatment. The need for stringent application of proper hygiene when using a probiotic preparation of this organism is emphasized. CASE REPORTSOutbreak cases. (i) Case 1. Case 1 involved a 34-year-old man hospitalized for hypoxia after head and thoracic trauma. He was placed on enteral nutrition, with insertion of a central venous catheter (CVC), and broad-spectrum antibiotic therapy was administered. On day 42 after admission (5 November 2000), he developed a fever, which was unsuccessfully treated with teicoplanin and imipenem. Multiple blood cultures yielded Saccharomyces cerevisiae. The fever and fungemia subsided under treatment with fluconazole at 400 mg/day. The CVC was removed 3 weeks after initiation of fluconazole treatment. The infectious episode resolved, but no catheter culture was performed.(ii) Case 2. Case 2 involved a 48-year-old man hospitalized for rupture of a cerebral aneurysm and fever. He was given enteral nutrition, and a CVC was inserted. Teicoplanin alone and then teicoplanin and meropenem were administered. On day 14 (10 November 2000), one blood culture yielded S. cerevisiae. On day 19, the CVC was removed and fluconazole therapy (400 mg/day) was immediately started. No catheter culture was performed. The fever subsided within 48 h of the initiation of fluconazole treatment.(iii) Case 3. Case 3 involved a 75-year-old woman admitted for acute myocardial infarction. She was given enteral nutrition, and a CVC was inserted. She was treated with various antibiotic regimens for several febrile episodes. On day 56 (10 April 2001), a blood culture yielded S. cerevisiae. The CVC was removed, leading to immediate defervescence. The CVC tip was positive for S. cerevisiae. Fluconazole therapy (400 mg/day) was started 2 days later and administered for 2 weeks.None of the three patients described above received any probiotic treatment. Case 4 (incomplete report).A 35-year-old woman with multiple traumas who had been hospitalized in the intensive care unit (ICU) at the same time as patients 1 and 2 had blood cultures positive for S. cerevisiae. Unfortunately, her medical record was sequestered for forensic purposes and whether she had received probiotic treatment or not could not be determined. This patient improved and was transferred to the orthopedic division, from which she was discharged 2 months later.The outbreak setting was an eight-bed ICU in a 400-bed secondary-care hospital in Rome, Italy. During the year preceding the outbreak, about 20% of the ICU patients were hospitalized for emergency surgery, 12% were hospitalized for elective surgery, 18% were hospitalized for trauma, and 50% were hospitalized for medical diseases. The mean (Ϯ standard deviation) age of patients was 66 Ϯ 16 years, the mean ICU hospitali...

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“…Der Einsatz von Saccharomyces sp. führte in Einzelfällen immunkompromittierter Patienten zum Auftreten einer Fungiämie [69]. Schwerwiegende Nebenwirkungen beim Einsatz von E. coli Stamm Nissle 1917 liegen bisher nicht vor.…”

Section: Sicherheit Von Probiotikaunclassified

Probiotika und Präbiotika - eine Renaissance?

Hoffmann

Kruis

2002

Der Internist

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Fungemia Due toSaccharomycesSpecies in a Patient Treated with EnteralSaccharomyces boulardii

Cited by 60 publications

References 2 publications

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Outbreak of Saccharomyces cerevisiae Subtype boulardii Fungemia in Patients Neighboring Those Treated with a Probiotic Preparation of the Organism

Probiotika und Präbiotika - eine Renaissance?

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