Probiotic sepsis in preterm neonates—a systematic review

Kulkarni, Tithi; Majarikar, Swati; Deshmukh, Mangesh; Ananthan, Anitha; Balasubramanian, Hari; Keil, Anthony D.; Patole, Sanjay

doi:10.1007/s00431-022-04452-5

Cited by 35 publications

(26 citation statements)

References 55 publications

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“…For instance, the popular probiotic strains Bifidobacterium and L. rhamnosus GG were found causative to bacteremia and sepsis in high-risk populations, with strain confirmation by metagenomic sequencing. [59][60][61][62][63][64][65][66][67][68] While bacteremia and sepsis by commercial probiotic strains absence of AR genes are still controllable by mainstream antibiotics such as ampicillin, introducing the broad spectrum of AR bacteria highly resistant to clinically important antibiotics associated with traditionally fermented foods presents an underestimated and potentially serious public health risk, especially to targeted populations suffering from various gut symptoms associated with "leaky gut" as well as compromised immune functions. Bacteremia and sepsis risk, antibiotic therapy failures, and further gut microbiota destruction after antibiotic treatment may significantly increase in targeted susceptible consumer populations who intend to repair the damaged gut microbiome by enhancing fermented food consumption.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of antibiotic resistance in traditionally fermented foods as a critical risk factor for host gut antibiotic resistome

Klein

et al. 2023

Preprint

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Disrupted gut microbiota as a critical risk factor for many noncommunicable diseases is largely driven by gut microbiota-impacting drugs, especially orally administered and biliary excreted antibiotics. Fermented food consumption has been encouraged to replenish disrupted gut microbiota; however, its overall impact on host gut health remains to be elucidated. This study examined traditionally fermented foods and the gut microbiota of consumers of fermented foods for antibiotic resistance. Dietary intervention with fermented foods was found to lead to a surge in the antibiotic resistome in the gut microbiota of most human subjects. The antibiotic resistome was further illustrated in traditionally fermented food samples, and antibiotic-resistant bacteria were isolated from approximately 90% of the retail kimchi and all artisan cheeses assessed in this pilot screening. The identified isolates included pathogens of importance in nosocomial infections such as Klebsiella pneumoniae and Enterococcus, as well as commensals and lactic acid bacteria, and some isolates exhibited extremely high minimum inhibitory concentration (MIC) against antibiotics of clinical significance. Exposing fermented food microbiota to representative antibiotics further led to a boost in the corresponding antibiotic and multidrug resistance gene pools and disturbed microbiota. The results revealed an underestimated public health risk associated with fermented food interventions, particularly in susceptible populations with gastrointestinal tract symptoms and compromised immune functions seeking gut microbiota rescue. These findings call for more comprehensive assessments of the benefits and potential safety challenges associated with traditionally fermented foods and strategic movements to mitigate unnecessary damage to the host gut microbiota and improve food safety.

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Section: Discussionmentioning

confidence: 99%

High prevalence of antibiotic resistance in traditionally fermented foods as a critical risk factor for host gut antibiotic resistome

Klein

et al. 2023

Preprint

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“…(2022) in a 6‐month‐old boy with risk factors and Kulkarni et al. (2022) in preterm neonates in intensive care units.…”

Section: Assessmentmentioning

confidence: 98%

“…It was associated with a good prognosis after treating the patients with antibiotics. Another (Kulkarni, 2022 ) was a review paper in pre‐term neonates. Based on the available evidence, the QPS status of Bifidobacterium spp.…”

Section: Assessmentmentioning

confidence: 99%

Update of the list of qualified presumption of safety (QPS) recommended microbiological agents intentionally added to food or feed as notified to EFSA 17: suitability of taxonomic units notified to EFSA until September 2022

Koutsoumanis¹,

Allende²,

Álvarez‐Ordóñez³

et al. 2023

EFS2

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The qualified presumption of safety (QPS) approach was developed to provide a regularly updated generic pre‐evaluation of the safety of microorganisms, intended for use in the food or feed chains, to support the work of EFSA's Scientific Panels. The QPS approach is based on an assessment of published data for each agent, with respect to its taxonomic identity, the body of relevant knowledge and safety concerns. Safety concerns identified for a taxonomic unit (TU) are, where possible, confirmed at the species/strain or product level and reflected by ‘qualifications’. In the period covered by this Statement, new information was found leading to the withdrawal of the qualification ‘absence of aminoglycoside production ability’ for Bacillus velezensis. The qualification for Bacillus paralicheniformis was changed to ‘absence of bacitracin production ability’. For the other TUs, no new information was found that would change the status of previously recommended QPS TUs. Of 52 microorganisms notified to EFSA between April and September 2022 (inclusive), 48 were not evaluated because: 7 were filamentous fungi, 3 were Enterococcus faecium , 2 were Escherichia coli , 1 was Streptomyces spp., and 35 were taxonomic units (TUs) that already have a QPS status. The other four TUs notified within this period, and one notified previously as a different species, which was recently reclassified, were evaluated for the first time for a possible QPS status: Xanthobacter spp. could not be assessed because it was not identified to the species level; Geobacillus thermodenitrificans is recommended for QPS status with the qualification ‘absence of toxigenic activity’. Streptoccus oralis is not recommended for QPS status. Ogataea polymorpha is proposed for QPS status with the qualification ‘for production purposes only’. Lactiplantibacillus argentoratensis (new species) is included in the QPS list.

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“…However, their role in the prevention of IFD in neonates is not clear since optimal strain, dosage, and duration of treatment are unknown, and there are concerns about the possibility of contamination [ 1 ]. Indeed, a recent systematic review [ 50 ] has shown the possibility, albeit rare, of invasive infections due to probiotics, especially in patients with comorbidities, and it must be stressed that probiotic yeasts, such as Saccharomyces boulardii/cerevisiae , can be very difficult to treat and are resistant to fluconazole [ 51 ].…”

Section: Other Prophylaxis Including Non-pharmacological Approachesmentioning

confidence: 99%

Prophylaxis of Invasive Fungal Infection in Neonates: A Narrative Review for Practical Purposes

Ferrando

Castagnola

2023

JoF

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Candida albicans is the most frequent cause of invasive fungal disease in preterm and/or low birth weight neonates, followed by Candida parapsilosis, whilst infections from other species are rare. Considering the severity of the disease, associated with poor clinical signs and diagnostic difficulties, primary prophylaxis becomes relevant. This paper summarizes the pathogenesis and clinical presentation of invasive candidiasis in neonates, focusing on prophylaxis. For late onset invasive disease, e.g., those occurring after the 3rd (or 7th according to some definitions) day of life possible approaches are the use of fluconazole, recommended in case of weight <1000 g or <1500 g if the local incidence of invasive candidiasis is higher than 2%, or the use of nystatin (for patients < 1500 g). Micafungin must be used in case of colonization by Candida auris, or in centers with a high prevalence of this pathogen. Concurrently, correct management of the central venous catheter and isolation procedures, with special regard to patients colonized by resistant strains, are fundamental. Other approaches such as reduced use of H2 blockers and broad-spectrum antibiotics (e.g., 3rd generation cephalosporins or carbapenems) and promotion of breast feeding proved useful. Reduction of early-onset infections (those occurring in the first 3 days of life) can also be obtained by treating maternal vulvo–vaginal candidiasis, which can represent a fastidious problem during pregnancy. In this case, topic azoles (the only recommendable treatment) can represent a kind of “prophylaxis” of early neonatal candidiasis. However, it must always be remembered that prophylaxis reduces the risk of invasive candidiasis but can not completely eliminate its occurrence, with the parallel risk of selecting for antifungal-resistant strains. Clinicians must maintain a high level of suspicion to start an appropriate therapy and strict epidemiological surveillance to identify the occurrence of clusters and the appearance of strains resistant to prophylaxis.

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Probiotic sepsis in preterm neonates—a systematic review

Cited by 35 publications

References 55 publications

High prevalence of antibiotic resistance in traditionally fermented foods as a critical risk factor for host gut antibiotic resistome

High prevalence of antibiotic resistance in traditionally fermented foods as a critical risk factor for host gut antibiotic resistome

Update of the list of qualified presumption of safety (QPS) recommended microbiological agents intentionally added to food or feed as notified to EFSA 17: suitability of taxonomic units notified to EFSA until September 2022

Prophylaxis of Invasive Fungal Infection in Neonates: A Narrative Review for Practical Purposes

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