Probiotics to the Rescue?

The news is full of the benefits of probiotic use. But what are they and are there any negative consequences to their use? According to WebMD (2018), Probiotics are live bacteria and yeasts. Probiotics are called "good bacteria" in the popular press because they help keep your gut healthy. They can be found in over the counter supplements and some foods. Many physicians recommend them for a variety of issues including digestive problems. The US Food and Drug Administration (FDA) regulates probiotics as a food source and not a medication.

How do probiotics work? When you lose "good" bacteria in your body, probiotics aids in replacing them to maintain GI balance. Scientists know that probiotics help send food through your gut by impacting nerves that control gut movement. Some common conditions probiotics are used to treat include (Nazario, 2018):

·       Irritable bowel syndrome

·       Inflammatory bowel disease (IBD)

·       Infectious diarrhea

·       Diarrhea caused by antibiotics

Literature also suggests probiotics can be used in other conditions (Nazario, 2018):

·       Skin conditions

·       Urinary and vaginal health

·       Preventing allergies and colds

·       Oral health

Many categories of bacteria are identified as probiotics. There are different benefits of each bacteria, but they can be generally classed into three groups (Nazario, 2018):

·       Lactobacillus. This is the most common probiotic found in yogurt and fermented foods. This probiotic helps with diarrhea and lactose intolerance.

·       Bifidobacterium. Found in dairy products, this can aid irritable bowel syndrome (IBS).

·       Saccharomyces boulardii is a yeast found in probiotics. It appears to help with diarrhea and other digestive problems.

 With the current fad of probiotics and the push in advertising, the widespread use of probiotics is guiding research into this product with some surprising results. Probiotics have been linked in some cases to Central line-associated bloodstream infections (CLABSIs). According to Cohen (2016) and Ostmann (2013), organisms incorporated in over-the-counter probiotics are causes of bacteremia in immunocompromised patients. Further studies evaluating this link of probiotics among high-risk patients are needed. In some oncology, probiotics are held on immunocompromised patients.

Recommendations in the literature have been made regarding the administration of probiotics to lessen the risk of bloodstream infections (Cohen, 2010). However, there is no mention or warnings about the possibility of environmental contamination or cross-transmission from hands to other sites from Lactobacillus. Skljarevski (2016) recommends patients receiving probiotics who have a central line and a feeding tube, have the probiotic capsules opened in a room separate from the patient. Staff should engage in proper hand hygiene before and after administration. The following sites share additional information on the connection of CLABSI and probiotic use.

https://www.ajicjournal.org/article/S0196-6553(13)00338-6/pdf

https://www.ajicjournal.org/article/S0196-6553(16)30824-0/fulltext?code=ymic-site

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490230/

https://www.ncbi.nlm.nih.gov/pubmed/27501401

References

Cohen, S., Woodfield, M., Boyle, N., Stednick, Z., Boeckh, M., Pergam, S. (2016). Incidence and outcomes of bloodstream infections among hematopoietic cell transplant recipients from species commonly reported to be in over-the-counter probiotic formulations. 18(5):699-705. doi: 10.1111/tid.12587.

Cohen, S.H., Gerding, D.N., Johnson, S., Kelly, C.P., Loo, V.G., McDonald, L.C. et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010; 31: 431–455

Nazario, B. (June 25, 2018). What Are Probiotics? WebMD Medical Reference. Retrieved Https://www.webmd.com/digestive-disorders/what-are-probiotics#1.

Ostmann, E., Hampton, L., Nicholas B.Merz, Liana Milligan, Paul Gase, Kathleen Woeltje, Keith F. et al. (2013). Review of Control Programs to Prevent Probiotic Related Central Line Associated Blood Stream Infections. American Journal of Infection Control, Volume 41 , Issue 6 , S23 - S24.

Skljarevski, S. et al. (2016). Preventing avoidable central line–associated bloodstream infections: Implications for probiotic administration and surveillance. American Journal of Infection Control, Volume 44, Issue 11, 1427 – 1428.

Greg Laukhuf RN, CRN, RN-BC, NE-BC