title: Lactobacillus bacteremia: Pathogen or prognostic marker?
abstract: OBJECTIVE
  Lactobacillus bacteremia is a rare event and its epidemiology is poorly known. Whether Lactobacillus bacteremia is a contaminant, a risk factor, or a risk marker of death remains an open question.
  
  
  METHODS
  We conducted a retrospective study of patients presenting with Lactobacillus bacteremia (LB), between January 2005 and December 2014, at the Grenoble University Hospital.
  
  
  RESULTS
  LB was observed in 38 patients (0.34% of all positive blood cultures). Cancer (40%), immunosuppression (37%), and use of central venous devices (29%) were frequently associated with LB. We observed a significant increase with time in the number of Lactobacillus positive blood cultures among all blood cultures performed (P=0.04). LBs were divided into two clinical-biological presentations: secondary bacteremia with a known portal of entry (n=30) and isolated bacteremia (n=8). Case fatality was 31% at D28, 55.2% at 1 year in the secondary bacteremia group, and 12.5% (both at D28 and 1 year) in the isolated bacteremia group. Secondary bacteremia with a known portal of entry was significantly associated with case fatality after adjustment for age, co-infection, cancer, immunosuppression, diabetes, and sex (OR 14.9 [1.04-216] P=0.047) for fatality at one year, but not for D28 fatality (P=0.14).
  
  
  CONCLUSIONS
  Lactobacillus bacteremia may be an important marker of disease severity rather than a pathogen, suggesting comorbidities. It should not be considered a contaminant, but should lead physicians to screen for associated infections and underlying diseases.
authors.affiliation: Chronic Granulomatous Disease Diagnosis and Research Centre (CDiReC), Therex-TIMC/Imag, UMR CNRS 5525, UJF-Grenoble 1, CHU de Grenoble, 38043 Grenoble, France; Nephrology Unit, Centre Hospitalier Annecy-Genevois, 74370 Metz-Tessy, France. Electronic address: bfranko@ch-annecygenevois.fr.
authors.forename: B
authors.initials: B
authors.lastname: Franko
authors.affiliation: Infectious department, Bacteriology, CHU Grenoble, 38043 Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Fournier
authors.affiliation: Nephrology Unit, CHU Grenoble, 38043 Grenoble, France.
authors.forename: T
authors.initials: T
authors.lastname: Jouve
authors.affiliation: Nephrology Unit, CHU Grenoble, 38043 Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Malvezzi
authors.affiliation: Infectious department, Bacteriology, CHU Grenoble, 38043 Grenoble, France.
authors.forename: I
authors.initials: I
authors.lastname: Pelloux
authors.affiliation: Infectious disease unit, CHU Grenoble, 38043 Grenoble, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Brion
authors.affiliation: Infectious disease unit, CHU Grenoble, 38043 Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Pavese
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007778:Lactobacillus; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
keywords: Bacteremia; Bactériémie; Lactobacillus