Lactobacillus Bacteremia in Pediatric Intensive Care Unit Patients Receiving Probiotics Kelly Flett MD,MMSc1, Preeti Mehrotra MD1, Gregory Priebe MD2, Thomas J Sandora MD,MPH1 Boston Children’s Hospital 1Division of Infectious Diseases and 2Department of Critical Care Medicine .
Background Details of Lactobacillus Administration Risk Factors for Bacteremia in the Pediatric ICU • NICU Case (n=6) Control (n=16) Probio cs such as Lactobacillus rhamnosus GG are 1% Patient Location # Doses % Total CICU N or % or N or % or increasingly used in hospitalized pa ents and 13% MICU Medical ICU 5859 37.2% mean 95% CI mean 95% CI OR[95% CI] within the intensive care unit (ICU). 37% Intermediate Care Demographics and Underlying MSICU Program (ICP) 4080 25.9% Condi ons 23% • Selected pa ents in the ICU may be at higher risk Sex (male) 6 100% 8 50% 7.3[1.2,∞] Medical/Surgical ICU 3560 22.6% Age(y) 10.0 [1.6,18.3] 6.5 [2.2,10.8] 1.0[0.9,1.2] ICP for Lactobacillus bacteremia, and restric on of Cardiac ICU 2114 13.4% Oncologic Diagnosis or Transplant 0 0% 0 0% NA 26% probio cs within these popula ons may be Neonatal ICU 123 0.8% Immunodeficiency 1 17% 4 25% 0.7[0,9.7] appropriate. Cardiac Disease 1 17% 9 56% 0.2[0,2.1] Prosthe c material 1 17% 7 44% 0.3[0,2.3] NG Other Administration Route # Doses % Total Objectives 4% 0% CVC days 181.4 [-209,572] 30.3 [14.1,46.5] 1.0[1.0,1.1] NJ G-tube 7369 46.8% Gastrointes nal Exposures 10% • To evaluate our ins tu onal usage of probio cs in Oral or skin breakdown 0 0% 0 0% NA Oral (PO) 3738 23.8% Diarrhea 0 0% 5 31% 0.4[0,2.5] ICU pa ents J-tube G-tube 15% 47% J-tube 2375 15.1% Parenteral Nutri on or Lipids 1 17% 3 19% 1.0[0,21.3] Gastrostomy or Jejunostomy 5 83% 11 69% 2.3[0.2,118] Nasojejunal (NJ) 1539 9.8% • To iden fy risk factors for Lactobacillus bacteremia PO Enteral Feeds 6 100% 15 94% 0.3[0.02,∞] 24% Nasogastric (NG) 697 4.4% Medica on Exposures in ICU pa ents receiving probio cs that contain Lactobacillus days of therapy since Lactobacillus species. Other 18 0.1% ICU admission 36.8 [-14.9,88.6] 28.1 [18.2,38.1] 1.0[1.0,1.1] Receipt of any an bio c 5 83% 12 75% 1.6[0.1,144] Methods and Study population Type of Probiotic # Doses % Total An bio c days of therapy within 7d 15.2 [2.8,27.6] 8.2 [6.0,10.3] 1.2[1.0,1.4] LA/LB Steroid(s) received 2 33% 4 25% 1.7[0.1,26.2] • From January 2009 – June 2014, 18 pa ents with 19% Lactobacillus Illness Severity Lactobacillus bacteremia were iden fied rhamnosus GG (LR) 12733 80.9% ECMO 1 17% 0 0% 3.0[0.2,∞] • Six of these pa ents were receiving probio cs and all Lactobacillus Surgery 1 17% 1 6% 3.0[0,235] Central Venous Catheter 5 83% 13 81% * were in the ICU LR acidophilus and 2998 19.1% 81% Urinary Catheter 2 33% 1 6% 6.0[0.3,354] • We conducted a case-control study to assess risk bulgaricus (LA/LB) Mechanical Ven la on 3 50% 4 25% 3.0[0.2,158] factors Vasopressor 1 17% 1 6% 1.0[0.1,∞] Other 5 0.0% • Cases were defined as pa ents in the ICU receiving Death 1 17% 1 6% 1.7[0,157] probio cs who developed Lactobacillus bacteremia ICU length of stay(d) 56.8 [-16.1,130] 66.7 [21.3,112] 0.9[0.6,1.0] • We matched each case to 3 controls who did not have Lactobacillus Administration in the Pediatric ICU Conclusions bacteremia but had received Lactobacillus within 90 from January 2009-June 2014 days of the date of bacteremia and who had an equal Probio c Doses Administered 15,736 • Despite a large number of administered doses in the ICU, or higher number of ICU days prior to censorship Lactobacillus bacteremia was a rare event • Risk factors were assessed during the 7 days prior to ICU Pa ents Receiving Probio cs 644 • Case pa ents were more likely to be male, but otherwise we did bacteremia (cases) or discharge (controls) Range of Doses per Pa ent 1 - 347 • Odds ra os were calculated with exact condi onal not iden fy addi onal risk factors for Lactobacillus bacteremia logis c regression Average Doses per Pa ent 24.4 • Mul -center studies will be needed to provide larger samples Incidence of Lactobacillus bacteremia / 1000 doses 0.4 sizes and iden fy risk factors *model did not converge