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NASHVILLE, Tenn. -- Among patients with central venous catheters in the intensive care unit (ICU), use of probiotic medications was associated with an increased incidence of central line infections and death, a retrospective study showed.

In an analysis of over 23,000 patients, the mortality rate for those with probiotic-associated central line infections (PACLIs) was 25.5% compared with 13.4% for those who did not develop these infections (OR 2.23, 95% CI 1.30-3.71, P<0.01), reported Scott Mayer, MD, of HCA HealthONE in Denver, during a presentation at CHEST 2022, the annual meeting of the American College of Chest Physicians.

"Our results suggest that any potential benefit of probiotic administration in the ICU is outweighed by the increased risk of mortality," Mayer said. "At the very least, eliminate the powder (probiotic) formulations because they offer no benefit over the tablets and carry an increased risk for infection mortality."

The study showed PACLIs to be more than twice as common among patients receiving powder formulations compared with other formulations (0.76% vs. 0.33%), with Mayer noting that this may be due to loose powder traveling through the air and contaminating the patient's central line.

In an interview with MedPage Today, Mayer said that the use of probiotics in the ICU is not uncommon and is often driven by patient preferences.

"Probiotics are being used these days for almost every condition you can think of and there are literally hundreds of brands and thousands of different products," he added. "If a patient has been taking them for dementia, for example, and they believe the probiotic they are on is helping, they are going to want to keep taking them in the ICU."

Despite their popularity, Mayer said there is little quality research showing that probiotics work for the long list of health maladies they are used to treat, including dementia, digestive disorders, and other gastrointestinal issues.

In 2020, the American Gastroenterological Association , noting that while certain probiotics may be beneficial for preventing Clostridium difficile infections in people who take antibiotics for a very specific complication of ulcerative colitis, there is, at present, insufficient evidence to recommend their use for the treatment of C. difficile, Crohn's disease, ulcerative colitis, and irritable bowel syndrome.

"Part of the problem is it is hard to conclude anything one way or another because there are so many different formulations," Mayer said. "So until there is actually compelling evidence to use them [in the ICU setting], I say don't do it because they can cause harm."

He noted that the identification of a PACLI is a laborious process that involves identifying the probiotics the patients were taking in the ICU, determining the bacteria and fungi in each individual probiotic, and confirming that the patient had blood cultures that were positive for one of the organisms present in the probiotic.

"We confirmed that the patient received the probiotic with a specific organism and that the blood culture was positive for that," he explained. "Probiotic infections have been known to occur in the ICU, but they have never been studied in this comprehensive manner."

This retrospective study analyzed data from the HCA Healthcare database and included adults who received probiotics while being treated in the ICU at acute care hospitals from October 2015 to October 2020.

Of the 23,015 patients included in the analysis, 86 (0.37%) developed a PACLI.

Patients with PACLIs were slightly more likely to be discharged from the hospital to rehabilitation (40.7% vs 39%) and more likely to be transferred to another hospital (3.49% vs 3.06%).

When Mayer and team examined infections related to the administration of more than a dozen specific probiotic organisms, they found similar infection rates across the board, with the lowest rate reported for Bifidobacterium longum probiotics (0.21%) and the highest rate among patients taking Saccharomyces boulardii probiotics (0.48%).

An analysis of specific patient comorbidities showed that gastrointestinal bleeds and immunosuppression were associated with the highest rate of PACLIs (15.12% and 11.63%, respectively).

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