title: A new risk factor for neonatal vancomycin-resistant Enterococcus colonisation: bacterial probiotics.
abstract: OBJECTIVE
  Vancomycin-resistant Enterococcus (VRE) colonisation can be controlled with strict adherence to infection control measures. We describe a VRE outbreak coincident with bacterial probiotic trial. Relationship between probiotic and VRE colonisation, and other possible risk factors were investigated.
  
  
  METHODS
  Two hundred and ten infants with gestational age less than 32 weeks had been randomised for a trial with probiotic preparation containing Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus plantarum, Bifidobacterium lactis, fructooligosaccharide, galactooligosaccharide, colostrums and lactoferrin (NBL probiotic ATP®; Nobel, Istanbul, Turkey) between February 2012 and August 2013 when a VRE outbreak also took place. The existence of a relationship between this probiotic preparation and VRE colonisation was investigated.
  
  
  RESULTS
  The begining and end of the outbreak were coincident with the beginning and end of the probiotic trial. Demographic and clinical features of neonates did not differ between VRE colonised (n = 94) and non-colonised infants (n = 116) except for vancomycin (p = 0.012) and probiotic (p < 0.001) use.
  
  
  CONCLUSIONS
  Probiotic and vancomycin exposure were significant risk factors for VRE colonisation. The acquisition and transfer of resistance genes of bacteria may be mediated by probiotics. Therefore, the safety of probiotics is a concern and should be investigated further.
authors.affiliation: a Neonatal Intensive Care Unit , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey.
authors.forename: Sevilay
authors.initials: S
authors.lastname: Topcuoglu
authors.forename: Tugba
authors.initials: T
authors.lastname: Gursoy
authors.forename: Fahri
authors.initials: F
authors.lastname: Ovalı
authors.forename: Ozge
authors.initials: O
authors.lastname: Serce
authors.forename: Guner
authors.initials: G
authors.lastname: Karatekin
mesh_terms: D001644:Bifidobacterium; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D005690:Galactose / Q000008:administration & dosage; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000382:microbiology*; D017053:Infection Control; D007778:Lactobacillus; D009844:Oligosaccharides / Q000008:administration & dosage; D019936:Probiotics / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D014421:Turkey; D065507:Vancomycin-Resistant Enterococci / Q000254:growth & development*
chemical_list: D009844:Oligosaccharides; C116580:fructooligosaccharide; D005690:Galactose
keywords: Newborn; probiotics; vancomycin-resistant Enterococcus