Probiotics tied to increased mortality among ICU patients: A boon or a hazard?

CHEST 2022: A recent analysis of over 23,000 patients, presented at the American College of Chest Physicians annual meeting, suggested that the increased risk of mortality outweighs the potential benefit of probiotic administration in the ICU. The team led by Mayer has analyzed that probiotic medication usage causes increased incidence of central line infections and death among patients with central venous catheters in the intensive care unit (ICU).

The researchers used the HCA Healthcare database data and included adults on probiotics in the ICU from October 2015 to October 2020. The main objective was to investigate the incidence of probiotic-associated central line infections (PACLIs) in the intensive care unit (ICU) setting.

The findings are published in CHEST.

Probiotics replenish the existing microbiome of the GIT. They have been proven effective against bloating, diarrhea, constipation, weight loss, etc. However, approved medical indications remain narrow. Probiotic infections occur in the ICU, but no detailed studies are available for elucidated comprehension.

The overall analysis could be summarised as follows:

• 23,015 patients fulfilled inclusion and exclusion criteria.

• The confirmation was based on the positive blood cultures for the organisms present in the probiotic.

• 86 patients in the analysis developed PACLIs. The incidence reported was 0.37%.

• The mortality rate for PACLIs compared to those who did not develop infection was 25.5% vs.13.4%.

• The Odds Ratio for mortality rate was 2.23, with P<0.01.

• Powder formulations offer no benefit over tablets and are associated with an increased risk for infection mortality.

• The mortality rate was higher in patients who contracted PACLI, as demonstrated by the Logistical regression compared to those who did not contract the infection.

• PACLIs were twice more common among patients taking powder formulations than other formulations and were recorded as 0.76% vs. 0.33%.

• Loose powder has a higher risk of contaminating the patient's central line.

• PACLI patients were more likely to get discharged from the hospital to rehabilitation and were recorded as 40.7% vs. 39%.

• PACLI patients were more likely to be transferred to another hospital and were recorded as 3.49% vs. 3.06%.

• The lowest infection rate was reported for Bifidobacterium longum probiotics, with an incidence of 0.21%.

• The highest infection rate was recorded among patients taking Saccharomyces boulardii probiotics, with an incidence of 0.48 %.

• Gastrointestinal bleeds and immunosuppression had the highest rate of PACLIs, recorded as 15.12%, and 11.63%, respectively.

The researchers wrote, " We determined the incidence of PACLI as the total number of infections (positive blood cultures) divided by the number of people at risk (patients on probiotics with a central venous catheter in place).

The co-author said, "Our study identified the largest collection of PACLIs. We conclude that Probiotic usage in ICU patients with central venous catheters causes increased incidence of PACLI and increased mortality. They added, "Protected catheters have decreased risk of external contamination and are at decreased risk of PACLI and mortality."

This analysis was presented on 10/17/2022 under the SESSION TITLE" Treatment Debates in Critical Care," and the type of session was Rapid Fire Original Inv.

Further Reading:

Mayer S, et al "Probiotic administration is associated with increased mortality in ICU patients with central venous catheters" CHEST 2022; DOI: 10.1016/j.chest.2022.08.912.