title: Breakthrough Lactobacillus rhamnosus GG bacteremia associated with probiotic use in an adult patient with severe active ulcerative colitis: case report and review of the literature.
abstract: BACKGROUND
  Probiotics are widely investigated in the treatment of various bowel diseases. However, they may also have a pathogenic potential, and the role of Lactobacillus spp. as opportunistic pathogens, mostly following disruption of the intestinal mucosa, is emerging.
  
  
  METHODS
  We report on a case of bacteremia caused by L. rhamnosus GG in an adult patient affected by severe active ulcerative colitis under treatment with corticosteroids and mesalazine. Lactobacillus bacteremia was associated with candidemia and occurred while the patient was receiving a probiotic formulation containing the same strain (as determined by PFGE typing), and was being concomitantly treated with i.v. vancomycin, to which the Lactobacillus strain was resistant. L. rhamnosus GG bacteremia, therefore, was apparently related with translocation of bacteria from the intestinal lumen to the blood.
  
  
  CONCLUSIONS
  Pending conclusive evidence, use of probiotics should be considered with caution in case of active severe inflammatory bowel diseases with mucosal disruption.
authors.affiliation: Internal Medicine Unit, Santa Maria Annunziata Hospital, 50012, Florence, Bagno a Ripoli, Italy. simonemeini2@gmail.com.
authors.forename: Simone
authors.initials: S
authors.lastname: Meini
authors.affiliation: Internal Medicine Unit, Santa Maria Annunziata Hospital, 50012, Florence, Bagno a Ripoli, Italy. raffaele.laureano@asf.toscana.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Laureano
authors.affiliation: Internal Medicine Unit, Santa Maria Annunziata Hospital, 50012, Florence, Bagno a Ripoli, Italy. lucia.fani@asf.toscana.it.
authors.forename: Lucia
authors.initials: L
authors.lastname: Fani
authors.affiliation: Infectious Diseases Unit, Cisanello Hospital, Pisa, Italy. c.tascini@ao-pisa.toscana.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tascini
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy. ngl.galano@gmail.com.
authors.forename: Angelo
authors.initials: A
authors.lastname: Galano
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy. albertoanton88@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy. gianmaria.rossolini@unifi.it.|Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy. gianmaria.rossolini@unifi.it.|Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. gianmaria.rossolini@unifi.it.
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D058387:Candidemia / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D003093:Colitis, Ulcerative / Q000150:complications* / Q000628:therapy*; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D052201:Lacticaseibacillus rhamnosus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D019804:Mesalamine / Q000008:administration & dosage; D008875:Middle Aged; D058889:Molecular Typing; D019936:Probiotics / Q000008:administration & dosage* / Q000009:adverse effects*; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D019804:Mesalamine; D014640:Vancomycin
keywords: Bacteremia; Lactobacillus rhamnosus; Probiotic; Ulcerative colitis