title: Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG.
abstract: Lactobacillus bacteremia is a rare entity, and its clinical significance is poorly defined. We have reviewed the risk factors and outcome for 89 case patients with Lactobacillus bacteremia. Species characterization was done in 53% of the cases, revealing 25 L. rhamnosus strains and 22 other Lactobacillus species. In 11 cases, the strain was identical with the probiotic L. rhamnosus GG. In 82% of the cases, the patients had severe or fatal comorbidities. Predisposing factors to bacteremia were immunosuppression, prior prolonged hospitalization, and prior surgical interventions. No significant differences were observed in these predisposing factors or clinical features between patients with cases associated with the various Lactobacillus species, other than higher C-reactive protein values in patients with L. rhamnosus bacteremia. Mortality was 26% at 1 month and was 48% at 1 year. In multivariate analysis, severe underlying diseases were a significant predictor for mortality (odds ratio [OR], 15.8), whereas treatment with antimicrobials effective in vitro was associated with lower mortality (OR, 0.22). We conclude that lactobacilli in blood cultures are of clinical significance and that their susceptibility should guide decisions about antimicrobial treatment.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. minna.salminen@hus.fi
authors.forename: Minna K
authors.initials: MK
authors.lastname: Salminen
authors.forename: Hilpi
authors.initials: H
authors.lastname: Rautelin
authors.forename: Soile
authors.initials: S
authors.lastname: Tynkkynen
authors.forename: Tuija
authors.initials: T
authors.lastname: Poussa
authors.forename: Maija
authors.initials: M
authors.lastname: Saxelin
authors.forename: Ville
authors.initials: V
authors.lastname: Valtonen
authors.forename: Asko
authors.initials: A
authors.lastname: Järvinen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007778:Lactobacillus; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019936:Probiotics / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents