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Observational Study
. 2023 Nov 1;51(11):1469-1478.
doi: 10.1097/CCM.0000000000005953. Epub 2023 Jun 1.

Probiotic-Associated Central Venous Catheter Bloodstream Infections Lead to Increased Mortality in the ICU

Scott Mayer  1 , Colin Bonhag  1 , Patrick Jenkins  2 , Brendon Cornett  3 , Paula Watts  1   4 , Dmitriy Scherbak  1   4
Affiliations
Observational Study

Probiotic-Associated Central Venous Catheter Bloodstream Infections Lead to Increased Mortality in the ICU

Scott Mayer et al. Crit Care Med. .

Abstract

Objectives: To determine the occurrence rate and impact on patient outcomes of probiotic-associated central venous catheter bloodstream infections in the ICU.

Design: Retrospective observational cohort study.

Setting: The cohort was gathered using HCA Healthcare's data warehouse.

Patients: Adult patients with central venous catheters in the ICU.

Interventions: None.

Measurements and main results: Blood culture data were used to determine whether an infection had occurred with an organism contained in an administered probiotic. Eighty-six probiotic-associated central venous catheter bloodstream infections were identified among the 23,015 patient cohort who received probiotics (0.37%). The number needed to harm was 270. Zero infections were found in the cohort that did not receive probiotics. Patients who contracted a probiotic infection had increased mortality (odds ratio, 2.23; 1.30-3.71; p < 0.01). Powder formulations had an increased rate of infection compared with nonpowder formulations (0.76% vs 0.33%; odds ratio, 2.03; 1.05-3.95; p = 0.04).

Conclusions: Probiotic administration is associated with a substantial rate of probiotic-associated bloodstream infection in ICU patients with central venous catheters in place. Probiotic-associated bloodstream infections result in significantly increased mortality. Powder formulations cause bloodstream infections more frequently than nonpowder formulations. In ICU patients with central venous catheters, the risks of probiotic-associated central venous catheter bloodstream infection and death outweigh any potential benefits of probiotic administration.

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Conflict of interest statement

Mr. Cornett received funding from HCA Healthcare. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

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