Use of Cultured Yogurt Causing Septic Shock and Intra-abdominal Abscesses Justin Fernandez, M.D., Maha Assi, M.D., M.P.H. KU School of Medicine-Wichita.
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Use of Cultured Yogurt Causing Septic Shock and Intra-abdominal Abscesses Justin Fernandez, M.D., Maha Assi, M.D., M.P.H. KU School of Medicine-Wichita 1 DISCLOSURE • I have no actual or potential conflict of interest in relation to this topic/presentation. 2 INTRODUCTION • Brewer’s/baker’s yeast, yogurts • Probiotic – live, beneficial Lactobacillus http://www.nutraingredients.com, http://www.art.com/ S. cerevisiae 3 PRODUCT CONTENTS Activia yogurt Bifidobacterium - Dannon lactis COST $0.70 / cup 100 million / gram Culturelle capsules Lactobacillus rhamnosus $1.06 / capsule 10 billion / capsule Jarrow capsules Saccharomyces boulardi $0.20 / capsule 5 billion / capsule 4 Patient 1: 65 M STEM CELL Abdominal pain / fever Indwelling catheter Yogurt ingestion CDAD ✔ ✔ ✔ ✔ Previous bowel surgery Septic Shock / Respiratory failure Lactobacillus Patient 3: 66 F LIVER ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Abdominal abscess S. cerevisiae Patient 2: 55 F KIDNEY ✔ ✔ 5 PRESENTATION • Asymptomatic <---------------> Septicemia • Pneumonia • Abscess • Endocarditis 6 Patients with fungemia caused by S. cerevisiae (60): • ICU – 60% • Enteral/parenteral nutrition – 71% • Use of probiotics – 26% Saccharomyces cerevisiae Fungemia: An Emerging Infectious Disease, Munoz et al. Madrid, Spain, 2003 7 Patients with invasive Saccharomyces infections (91): • Central venous catheter – 95% • Previous antibiotics – 87% • Digestive tract disease – 64% Invasive Saccharomyces Infection: A Comprehensive Review, Enache et al. Paris, France, 2005 8 Patients with Lactobacillus bacteremia (89): • Fatal conditions – 80-90% • Previous antibiotic use – 52% • Mechanically ventilated – 45% Lactobacillus Bacteremia, Clinical Significance, and Patient Outcome, Salminen et al. Tampere, Finland, 2004 9 Patients with Lactobacillus bacteremia: Lactobacillus Bacteremia and Endocarditis: Review of 45 Cases, Rola et al. Cleveland, Ohio, 1997 10 WHY HAPPENING? • • • • Higher population at risk Immunosuppressive drugs Broad spectrum antiobiotics Parenteral nutrition 11 WHY RELEVANT? • Ubiquitous • “An Emerging Infectious Disease” 50 40 30 20 10 0 Reported Cases 1970-1980 1981-1990 1991-2004 Saccharomyces cerevisiae Fungemia: An Emerging Infectious Disease, Munoz et al. Madrid, Spain 12 OFFICIAL RECOMMENDATION (IDSA) • Saccharomyces + po Vancomycin C. diff recurrences • Potential fungemia if immunocompromised • Avoid if critically ill • No compelling evidence with other probiotics http://www.idsociety.org 13 SAFE? ORGANIZATION ANTIBIOTIC ASSOCIATED DIARRHEA CLOSTRIDIUM DIFFICILE ASSOCATED DIARRHEA (CDAD) ACP (Dr. Thomas Fekete – 2013) Yes – with caution UK Health Protection Agency Does not recommend use Society for Healthcare Epidemiology of America Does not recommend use Infectious Diseases Society of America Does not recommend use World Gastroenterology Organization Strong evidence Safe to use 14 LOCAL and NATIONAL HOSPITAL LOCATION GENERAL PRACTICE Via Christi Medical Center Wichita, KS <50% of time Wesley Medical Center Wichita, KS 50% KU Medical Center Kansas City, KS <50% (“last ditch effort”) UCLA Medical Center Santa Monica, CA Very common, continued in house if pt taking as outpatient New York Presbyterian Medical Center New York, NY “make probiotics a habit,” caution if immunocompromised 15 CONCLUSION • BENEFIT should clearly outweigh RISK • HOWEVER…IF Immunocompromised Bowel compromise Comorbidities Central Venous Catheter • THEN… CAUTION!!! 16 NO INTERVENTION IS BENIGN 17 REFERENCES 1. Stein PD, Folkens AT, Hruska KA. Saccharomyces fungemia. Chest 1970; 58:173–5 2. Saccharomyces boulardii in critically ill patients. Intensive Care Med 2002; 28:797–801. , Piarroux R, Millon L, Bardonnet K, Vagner O, Koenig H. Are live saccharomyces yeasts harmful to patients? Lancet 1999; 353:1851–2 Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL 3. The epidemiological features of invasive mycotic infections in the San Francisco Bay Area, 1992–1993: results of population-based laboratory active surveillance. Clin Infect Dis 1998; 27:1138–47. Stein PD, Folkens AT, Hruska KA. Saccharomyces fungemia. Chest 1970; 58:173–5 4. Seven cases of fungemia with Saccharomyces boulardii in critically ill patients. Intensive Care Med 2002; 28:797–801. , Piarroux R, Millon L, Bardonnet K, Vagner O, Koenig H. 5. Are live saccharomyces yeasts harmful to patients? Lancet 1999; 353:1851–2 6. Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL. The epidemiological features of invasive mycotic infections in the San Francisco Bay Area, 1992– 1993: results of population-based laboratory active surveillance. Clin Infect Dis 1998; 27:1138–47. 7. Hennequin C, Kauffmann-Lacroix C, Jobert A, et al. Possible role of catheters in Saccharomyces boulardii fungemia. Eur J Clin Microbiol Infect Dis 2000; 19:16–20 8. Piarroux R, Millon L, Bardonnet K, Vagner O, Koenig H. Are live saccharomyces yeasts harmful to patients? Lancet 1999; 353:1851–2. 9. Perapoch J, Planes AM, Querol A, et al. Fungemia with Saccharomyces cerevisiae in two newborns, only one of whom had been treated with ultra-levura. Eur J Clin Microbiol Infect Dis 2000; 19:468–70 10. Hennequin C, Kauffmann-Lacroix C, Jobert A, et al. Possible role of catheters in Saccharomyces boulardii fungemia. Eur J Clin Microbiol Infect Dis 2000; 19:16–20 18 11. Saccharomyces cerevisiae Fungemia: An Emerging Infectious Disease Patricia Mun˜ oz,1 Emilio Bouza,1 Manuel Cuenca-Estrella,3 Jose Marı´a Eiros,1 Maria Jesu´s Pe´ rez,2 Mar Sa´nchez-Somolinos,1 Cristina Rinco´n,2 Javier Hortal,2 and Teresa Pela´ez1 Departments of 1Clinical Microbiology and Infectious Diseases and 2Heart Surgery, Hospital General Universitario “Gregorio Maran˜o´n,”Universidad Complutense, and 3Centro Nacional de Microbiologı´a, Instituto de Salud Carlos III, Madrid, Spain 12. Salonen JH, Richardson MD, Gallacher K, et al. Fungal colonization of haematological patients receiving cytotoxic chemotherapy: emergence emergenceof azole-resistant Saccharomyces cerevisiae. J Hosp Infect 2000; 45:293–301 13. Jensen DP, Smith DL. Fever of unknown origin secondary to brewer’s yeast ingestion. Arch Intern Med 1976; 136:332–3. 14. McCusker JH, Clemons KV, Stevens DA, Davis RW. 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Two Cases of Vaginitis Caused by Itraconazole-Resistant Saccharomyces cerevisiae and a Review of Recently Published Studies Vincenzo Savini Chiara Catavitello Assunta Manna Marzia Talia Fabio Febbo Andrea Balbinot Francesco D’Antonio Giovanni Di Bonaventura Claudio Celentano Marco Liberati Raffaele Piccolomini Domenico D’Antonio 19 20. Rosa de Llanos a, Amparo Querol a, Javier Pemán b, Miguel Gobernado b, María Teresa Fernández-Espinar a,⁎ a Departamento de Biotecnología, Instituto de Agroquímica y Tecnología de los Alimentos (CSIC), 46100 Burjassot, Valencia, Spain b Servicio de Microbiología, Hospital Universitario La Fe, Valencia, Spain Received 2 December 2005; received in revised form 1 March 2006; accepted 25 April 2006 21. Guslandi M., G. Mezzi, M. Sorghi, and P. A. Testoni. 2000. Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig. Dis. Sci. 68: 5998– 6004 22. Hennequin, C., C. Kauffmann-Lacroix, A. Jobert, J. P. Viard, C. Ricour, J. L. Jacquemin, and P. Berche. 2000. Possible role of catheters in Saccharomyces boulardii fungemia. Eur. J. Clin. Microbiol. Infect. Dis. 19:16–20 23. Outbreak of Saccharomyces cerevisiae Subtype boulardii Fungemia in Patients Neighboring Those Treated with a Probiotic Preparation of the Organism Marco Cassone,1* Pietro Serra,1 Francesca Mondello,2 Antonietta Girolamo,2 Sandro Scafetti,3 Eleonora Pistella,1 and Mario Venditti1 III Clinica Medica, Dipartimento di Medicina Clinica, Universita` degli Studi di Roma “La Sapienza,”1 Dipartimento di Malattie infettive, parassitarie ed immunomediate, Istituto Superiore di Sanita`,2 and Reparto di Rianimazione e Terapia Intensiva, Ospedale “Sandro Pertini,”3 Rome, Italy 24. Stein P, Folkens A, Hruska K. Saccharomyces fungemia. Chest 1970; 58:173–5 25. Saccharomyces cerevisiae Fungemia After Saccharomyces boulardii Treatment in Immunocompromised Patients Riquelme, Arnoldo J. M.D.; Calvo, Mario A. M.D.; Guzmán, Ana M. M.D.; Depix, María S.; García, Patricia M.D.; Pérez, Carlos M.D.; Arrese, Marco M.D.; Abarca, Jaime A. M.D. 26. Castagliuolo I, LaMont JT, Nikulasson ST, Pothoulakis C. Saccharomyces boulardii pro- tease inhibits Clostridium difficile toxin A effects in the rat ileum. Infect Immun 1996; 64: 5225–32 27. Castagliuolo I, LaMont JT, Nikulasson ST, Pothoulakis C. Saccharomyces boulardii pro- tease inhibits Clostridium difficile toxin A effects in the rat ileum. Infect Immun 1996; 64: 5225–32 20 28. Saccharomyces cerevisiae Fungemia: An Adverse Effect of Saccharomyces boulardii Probiotic Administration Raoul Herbrecht and Yasmine Nivoix Department of Hematology and Oncology and Pharmacy, Hoˆpital de Hautepierre, Strasbourg, France 29. Shadi Hamoud MD1, Zohar Keidar MD2 and Tony Hayek MD1 Departments of 1Internal Medicine E and 2Nuclear Medicine, Rambam Medical Center, Haifa, Israel 30. Aguirre M, Collins MD. Lactic acid bacteria and human clinical infection. J Appl Bacteriol 1993;75:95-107 31. Lactobacillus Bacteremia, Clinical Significance, and Patient Outcome, with Special Focus on Probiotic L. Rhamnosus GG Minna K. Salminen1, Hilpi Rautelin2, Soile Tynkkynen3, Tuija Poussa4, Maija Saxelin3, Ville Valtonen1, and Asko Järvinen1 32. Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection Mary Hickson 33. Lactobacillus Bacteremia and Endocarditis: Review of 45 Cases Rola N. Husni, Steven M. Gordon, John A. Washington, From the Departments of Infectious Diseases and Clinical Pathology, and David L. Longworth The Cleveland Clinic Foundation, Cleveland, Ohio 34. Probiotics for the Prevention and Treatment of Antibiotic-Associated DiarrheaA Systematic Review and Meta-analysis FREESusanne Hempel, PhD; Sydne J. Newberry, PhD; Alicia R. Maher, MD; Zhen Wang, PhD; Jeremy N. V. Miles, PhD; Roberta Shanman, MS; Breanne Johnsen, BS; Paul G. Shekelle, MD, PhD 35. http://www.idsociety.org 21 QUESTIONS 22