Saccharomyces Cerevisiae (incl S Boulardii) May Cause Fungemia in Critically Ill Patients

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In France, Ultralevure (made of S. Boulardii) is routinely prescribed by doctors to prevent abx related diarrhea.

Nelly

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"This review confirms that the most important risk factor for S. cerevisiae fungemia is the use of probiotics," write Dr. Raoul Herbrecht and Dr. Yasmine Nivoix from Hopital de Hautepierre, Strasbourg, France in a related editorial.

"This raises the question of the risk-benefit ratio of these agents in critically ill or immunocompromised patients who are likely to develop an infection after exposure to high amounts of a pathogen with a low virulence."

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Saccharomyces Cerevisiae May Cause Fungemia in Critically Ill Patients

NEW YORK (Reuters Health) Jun 03 - Treatment with the probiotic Saccharomyces cerevisiae may lead to fungemia in immunosuppressed or critically ill patients, investigators in Madrid report.

S. cerevisiae is commonly used as a probiotic for the treatment of antibiotic-related diarrhea, Dr. Munoz from Hospital General Universitario "Gregorio Maranon," and colleagues explain.

They identified three patients with S. cerevisiae fungemia in an intensive care unit and reviewed the literature to identify similar cases. All three patients had been treated for Clostridium difficile-associated diarrhea with Ultralevura, a formulation of S. boulardii (a strain of S. cerevisiae), the authors report, and all three died of various causes.

The strains isolated from the three patients were identical to the strains from the probiotic formulation, according to the results in the June 1st issue of Clinical Infectious Diseases. No further cases were detected after the discontinuation of Ultralevura in the intensive care unit.

Review of the literature identified 57 additional cases of S. cerevisiae fungemia, the researchers note, and at least 31 patients were receiving probiotics or potentially exposed to other patients who were receiving probiotics.

The mortality rate among the reported cases of S. cerevisiae fungemia was 28%.

"The extent of this review indicates that S. cerevisiae should be considered as a well-established cause of nosocomially acquired yeast infection, particularly in patients receiving prophylaxis or treatment with the probiotic Ultralevura, which should be considered a risk factor for nosocomial bloodstream infection in patients with predisposing underlying conditions," the authors conclude.

"Therapy for S. cerevisiae fungemia should rely on the withdrawal of the probiotic preparation, if it was being given, administration of an antifungal agent, and, as with other types of fungemia, withdrawal of central venous catheters," the researchers advise.

"Until more data are available," the investigators suggest, "the antifungal agent of choice seems to be amphotericin B."

"This review confirms that the most important risk factor for S. cerevisiae fungemia is the use of probiotics," write Dr. Raoul Herbrecht and Dr. Yasmine Nivoix from Hopital de Hautepierre, Strasbourg, France in a related editorial.

"This raises the question of the risk-benefit ratio of these agents in critically ill or immunocompromised patients who are likely to develop an infection after exposure to high amounts of a pathogen with a low virulence."

"S. boulardii should certainly be contraindicated for patients of fragile health, as well as for patients with a central venous catheter in place," the editorialists conclude. "Whether this probiotic still has a place in less severe situations needs to be reassessed."

Clin Infect Dis 2005;40:1625-1637.