title: Oral supplementation with Lactobacillus casei subspecies rhamnosus prevents enteric colonization by Candida species in preterm neonates: a randomized study.
abstract: BACKGROUND
  Colonization by Candida species is the most important predictor of the development of invasive fungal disease in preterm neonates, and the enteric reservoir is a major site of colonization. We evaluated the effectiveness of an orally supplemented probiotic (Lactobacillus casei subspecies rhamnosus; Dicoflor [Dicofarm spa]; 6 x 10(9) cfu/day) in the prevention of gastrointestinal colonization by Candida species in preterm, very low birth weight (i.e., < 1500-g) neonates during their stay in a neonatal intensive care unit.
  
  
  METHODS
  Over a 12-month period, a prospective, randomized, blind, clinical trial that involved 80 preterm neonates with a very low birth weight was conducted in a large tertiary neonatal intensive care unit. During the first 3 days of life, the neonates were randomly assigned to receive either an oral probiotic added to human (maternal or pooled donors') milk (group A) or human milk alone (group B) for 6 weeks or until discharge from the NICU, if the neonate was discharged before 6 weeks. On a weekly basis, specimens obtained from various sites (i.e., oropharyngeal, stool, gastric aspirate, and rectal specimens) were collected from all patients for surveillance culture, to assess the occurrence and intensity of fungal colonization in the gastrointestinal tract.
  
  
  RESULTS
  The incidence of fungal enteric colonization (with colonization defined as at least 1 positive culture result for specimens obtained from at least 1 site) was significantly lower in group A than in group B (23.1% vs. 48.8%; relative risk, 0.315 [95% confidence interval, 0.120-0.826]; P = .01). The numbers of fungal isolates obtained from each neonate (P = .005) and from each colonized patient (P = .005) were also lower in group A than in group B. L. casei subspecies rhamnosus was more effective in the subgroup of neonates with a birth weight of 1001-1500 g. There were no changes in the relative proportions of the different Candida strains. No adverse effects potentially associated with the probiotic were recorded.
  
  
  CONCLUSIONS
  Orally administered L. casei subspecies rhamnosus significantly reduces the incidence and the intensity of enteric colonization by Candida species among very low birth weight neonates.
authors.affiliation: Neonatology and Hospital Neonatal Intensive Care Unit, Azienda Ospedaliera Regina Margherita-S. Anna, Turin, Italy. paolomanzoni@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Manzoni
authors.forename: M
authors.initials: M
authors.lastname: Mostert
authors.forename: M L
authors.initials: ML
authors.lastname: Leonessa
authors.forename: C
authors.initials: C
authors.lastname: Priolo
authors.forename: D
authors.initials: D
authors.lastname: Farina
authors.forename: C
authors.initials: C
authors.lastname: Monetti
authors.forename: M A
authors.initials: MA
authors.lastname: Latino
authors.forename: G
authors.initials: G
authors.lastname: Gomirato
mesh_terms: D000284:Administration, Oral; D002175:Candida / Q000145:classification / Q000302:isolation & purification / Q000502:physiology*; D002177:Candidiasis / Q000151:congenital / Q000517:prevention & control*; D004064:Digestive System / Q000382:microbiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D052201:Lacticaseibacillus rhamnosus / Q000502:physiology*; D019936:Probiotics / Q000008:administration & dosage* / Q000627:therapeutic use*