Invasive Infections Associated with the Use of Probiotics in Children: A Systematic Review

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.

Paraprobiotics and Postbiotics of Lactobacillus delbrueckii CIDCA 133 Mitigate 5-FU-Induced Intestinal Inflammation

“…Although some preclinical studies report the host’s beneficial effects related to “live” probiotics consumption [ 16 , 17 , 18 , 19 , 20 ], there are many questions regarding their safety concerns in clinical practice, especially in premature infants or immune-compromised patients. In these conditions, probiotics can translocate into the blood system and increase the risk of systemic infections [ 21 , 22 , 23 , 24 ]. The use of non-viable/inactivated probiotics, known as paraprobiotics (e.g., heat-killed probiotics) or products/molecules secreted or derived from these microorganisms, known as postbiotics (e.g., cell-free supernatant, surface layer proteins, cell lysates), besides minimizing or avoiding these possible adverse effects, has also been evaluated in anti-inflammatory therapies [ 25 , 26 ].…”

Heat-inactivated Lacticaseibacillus paracasei N1115 alleviates the damage due to brain function caused by long-term antibiotic cocktail exposure in mice

“…In this study, heat-inactivated N1115 significantly upregulated IL-1β and IL-6 levels in the Abx + N1115 group. There was a systematic review study found that some probiotics as exogenous substances to cause infections in children [ 50 ]. In our study, the long-term use of antibiotics suppressed the immune system, and we suspect that heat-inactivated N1115 as an exogenous antigen that stimulated the immune system and enhanced the immune response.…”

Hygiene Aspects of Premature Nutrition

“…It seems that there is a shortage of some bioactive ingredients in the formula, which are present in breastmilk [7]. However, the risk of probiotic sepsis remains one of the concerns linked to this kind of supplementation, especially in preterm infants [9][10][11][12]. Invasive diseases linked to probiotics are reported rarely and have never been seen in a randomised clinical trial [8].…”