title: Seven cases of Saccharomyces fungaemia related to use of probiotics.
abstract: Probiotics are increasingly used in critically ill patients without enough safety data. The aim of the present study was to determine the association of probiotics with Saccharomyces cerevisiae fungaemia. Seven patients with S. cerevisiae fungaemia were reported at two hospitals in India between July 2014 and September 2015. Detailed clinical history of patients was recorded. Besides the seven patient isolates, three probiotics sachets used in those patients and five unrelated clinical isolates were used for association study by Fluorescent amplified fragment length polymorphism (FAFLP). Antifungal susceptibility testing was performed by broth microdilution technique of CLSI (M27-A3) and interpreted according to CLSI (M27S4). Two patients were premature neonates and five were adults. They were admitted in intensive care unit and were on probiotics containing S. boulardii (except one adult patient). FAFLP analysis showed 96.4-99.7% similarity between blood and corresponding probiotic isolates. Of the three AFLP types (group I, II, II) identified, all the probiotic isolates clustered in group I (major cluster) including majority of the blood isolates. The isolates were susceptible to all antifungal agents tested. Five patients, who could be evaluated, responded promptly to echinocandins or voriconazole. As the prescription of probiotic containing S. boulardii in critically ill patient's leads to the fungaemia, we recommend avoiding this probiotic in those patients.
authors.affiliation: Apollo Gleneagles Hospitals, Kolkata, India.
authors.forename: Ujjwayini
authors.initials: U
authors.lastname: Roy
authors.affiliation: Apollo Hospitals, Chennai, India.
authors.forename: Laxman G
authors.initials: LG
authors.lastname: Jessani
authors.affiliation: Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Shivaprakash M
authors.identifier: http://orcid.org/0000-0002-9097-9253
authors.initials: SM
authors.lastname: Rudramurthy
authors.affiliation: Apollo Hospitals, Chennai, India.
authors.forename: Ram
authors.initials: R
authors.lastname: Gopalakrishnan
authors.affiliation: Apollo Gleneagles Hospitals, Kolkata, India.
authors.forename: Soma
authors.initials: S
authors.lastname: Dutta
authors.affiliation: Apollo Gleneagles Hospitals, Kolkata, India.
authors.forename: Chandrashish
authors.initials: C
authors.lastname: Chakravarty
authors.affiliation: Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Joseph
authors.initials: J
authors.lastname: Jillwin
authors.affiliation: Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Arunaloke
authors.identifier: http://orcid.org/0000-0003-1555-3807
authors.initials: A
authors.lastname: Chakrabarti
mesh_terms: D000328:Adult; D000368:Aged; D054458:Amplified Fragment Length Polymorphism Analysis; D000935:Antifungal Agents / Q000627:therapeutic use; D016638:Critical Illness / Q000628:therapy; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D016469:Fungemia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007194:India; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D005810:Multigene Family; D019936:Probiotics / Q000008:administration & dosage / Q000009:adverse effects*; D012335:RNA, Ribosomal / Q000235:genetics; D000069983:Saccharomyces boulardii / Q000302:isolation & purification; D012441:Saccharomyces cerevisiae / Q000302:isolation & purification*; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D012335:RNA, Ribosomal; C065096:RNA, ribosomal, 26S; D065819:Voriconazole
keywords: 
  Saccharomyces
  ; fungaemia; management; outcome; probiotics