Seven cases of Saccharomyces fungaemia related to use of probiotics

Abstract

Probiotics are increasingly used in critically ill patients without enough safety data. The aim of the present study was to determine the association of probiotics with Saccharomyces cerevisiae fungaemia. Seven patients with S. cerevisiae fungaemia were reported at two hospitals in India between July 2014 and September 2015. Detailed clinical history of patients was recorded. Besides the seven patient isolates, three probiotics sachets used in those patients and five unrelated clinical isolates were used for association study by Fluorescent amplified fragment length polymorphism (FAFLP). Antifungal susceptibility testing was performed by broth microdilution technique of CLSI (M27-A3) and interpreted according to CLSI (M27S4). Two patients were premature neonates and five were adults. They were admitted in intensive care unit and were on probiotics containing S. boulardii (except one adult patient). FAFLP analysis showed 96.4-99.7% similarity between blood and corresponding probiotic isolates. Of the three AFLP types (group I, II, II) identified, all the probiotic isolates clustered in group I (major cluster) including majority of the blood isolates. The isolates were susceptible to all antifungal agents tested. Five patients, who could be evaluated, responded promptly to echinocandins or voriconazole. As the prescription of probiotic containing S. boulardii in critically ill patient's leads to the fungaemia, we recommend avoiding this probiotic in those patients.

Review: Are there indigenous Saccharomyces in the digestive tract of livestock animal species? Implications for health, nutrition and productivity traits

“…Given the source (e.g. fruit's skin) of the original S. boulardii strain, it can be argued that at least this strain is not an obligate anaerobe and is definitely not indigenous to the human or animal gut, yet there is enough evidence to suggest that this (foreign) organism can have a significant effect on human health; however, questions remain about its safety (Roy et al, 2017) as in the case of S. cerevisiae (Strope et al, 2015). The risk of disease is not exclusive to consumption of Saccharomyces or any other particular probiotic or combination of probiotics either in humans or in animals.…”

Bacterial, Gut Microbiome-Modifying Therapies to Defend against Multidrug Resistant Organisms

“…Most probiotic companies do not genotype their bacteria or assess the presence of AMR genes [32], although Cabana et al noted that reputable companies follow good manufacturing procedures and test for AMR genes, which can be verified by consumers [33]. While the debate over the safety of probiotic use in healthy individuals is ongoing, several clinicians and researchers have voiced concern over probiotic use in immunocompromised populations [34][35][36][37]. Side effects, even in healthy populations, can include infections, immune stimulation, production of harmful byproducts, and the spread of AMR genes [38].…”

Application ofSaccharomyces cerevisiae var. boulardiiin food processing: a review

“…Nevertheless, the security of S. boulardii as biotherapeutic agent has been questioned due to registered cases of fungaemia (Martin et al 2017). In fact, S. boulardii has been contraindicated for persons with fragile health and in immunocompromised and critically ill patients (Atici et al 2017;Roy et al 2017), as well as for patients with a central venous catheter in place (Ricci et al 2017). However, these authors did not report any fungaemia related to the supplementation of S. boulardii in food.…”