title: Saccharomyces cerevisiae fungemia: an emerging infectious disease.
abstract: BACKGROUND
  Saccharomyces cerevisiae is well known in the baking and brewing industry and is also used as a probiotic in humans. However, it is a very uncommon cause of infection in humans.
  
  
  METHODS
  During the period of 15-30 April 2003, we found 3 patients with S. cerevisiae fungemia in an intensive care unit (ICU). An epidemiological study was performed, and the medical records for all patients who were in the unit during the second half of April were assessed.
  
  
  RESULTS
  The only identified risk factor for S. cerevisiae infection was treatment with a probiotic containing Saccharomyces boulardii (Ultralevura; Bristol-Myers Squibb). This probiotic is used in Europe for the treatment and prevention of Clostridium difficile-associated diarrhea. The 3 patients received the product via nasograstric tube for a mean duration of 8.5 days before the culture result was positive, whereas only 2 of 41 control subjects had received it. Surveillance cultures for the control patients admitted at the same time did not reveal any carriers of the yeast. Strains from the probiotic capsules and the clinical isolates were identified as S. cerevisiae, with identical DNA fingerprinting. Discontinuation of use of the product in the unit stopped the outbreak of infection. A review of the literature identified another 57 cases of S. cerevisiae fungemia. Overall, 60% of these patients were in the ICU, and 71% were receiving enteral or parenteral nutrition. Use of probiotics was detected in 26 patients, and 17 patients died.
  
  
  CONCLUSIONS
  Use of S. cerevisiae probiotics should be carefully reassessed, particularly in immunosuppressed or critically ill patients.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain. pmunoz@micro.hggm.es
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.forename: Manuel
authors.initials: M
authors.lastname: Cuenca-Estrella
authors.forename: Jose María
authors.initials: JM
authors.lastname: Eiros
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Pérez
authors.forename: Mar
authors.initials: M
authors.lastname: Sánchez-Somolinos
authors.forename: Cristina
authors.initials: C
authors.lastname: Rincón
authors.forename: Javier
authors.initials: J
authors.lastname: Hortal
authors.forename: Teresa
authors.initials: T
authors.lastname: Peláez
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D021821:Communicable Diseases, Emerging / Q000382:microbiology*; D004196:Disease Outbreaks; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D019936:Probiotics / Q000009:adverse effects; D012441:Saccharomyces cerevisiae / Q000302:isolation & purification*
chemical_list: D000935:Antifungal Agents