Monday, February 10, 2020

Probiotics in ICU: UPDATED

It certainly got me thinking when several people messaged and commented to me regarding their hospitals not allowing probiotics on their ICU patients. I decided to take a little bit of time to see if this was an old habit that just doesn't die, you know, a resistance to change, or if it's something substantiated by data. 

At first I didn't find anything to substantiate the claims. Key words were "at first". Now I understand what they're talking about and I even more appreciate the fund of knowledge that this page brings to the medical community. 

The exact mechanism, whether translocation from the gut, contamination with a central line, or something else is unknown. What is known is that 1.1% (6 of 522) of the patients at this facility who received probiotics developed a bacteremia related to the probiotic agent. That's not a large number but at the same time a large number in my opinion. I'll stress again, my opinion, not medical advice. I do not want to cause harm to my ICU patients. For those wondering, these patients were not severely immunocompromised nor did they have bowel disintegrity. 

I will wait until more data comes out before I start implementing this in my practice. As always, I appreciate the insight that you all provide. 

A hat tip to the authors. 

-EJ

Yelin, I.; Flett, K.B.; Merakou, C.; Mehrotra, P.; Stam, J.; Snesrud, E.; Hinkle, M.; Lesho, E.; McGann, P.; McAdam, A.J.; et al. Genomic and epidemiological evidence of bacterial transmission from probiotic capsule to blood in ICU patients. Nat. Med. 2019, 25, 1728–1732.








Link to the Article

Yelin, I.; Flett, K.B.; Merakou, C.; Mehrotra, P.; Stam, J.; Snesrud, E.; Hinkle, M.; Lesho, E.; McGann, P.; McAdam, A.J.; et al. Genomic and epidemiological evidence of bacterial transmission from probiotic capsule to blood in ICU patients. Nat. Med. 2019, 25, 1728–1732.

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