Case Series of Bacteremia Associated with Probiotic Use in Children after Cardiac Surgery, China.

Probiotic-associated bacteremia occurred in 6 out of 5,034 children who received probiotics after cardiac surgery.

• The study cohort included 16,436 children who underwent cardiac surgery during 2019-2024 in China.
• 5,034 of the total cohort received probiotics.
• 6 patients developed bacteremia with probiotic strains, representing a rare complication.
• Causative organisms identified were Bacillus subtilis, Bacillus licheniformis, and Lacticaseibacillus rhamnosus.

Three cases of probiotic-associated bacteremia occurred in children who had not directly received probiotics.

• These 3 cases suggest potential cross-contamination or catheter-related transmission.
• This finding indicates that probiotic-associated bacteremia can occur even in patients not directly administered probiotics.
• Central venous catheters were present in all 6 cases, suggesting a possible transmission route.

All 6 patients with probiotic-associated bacteremia had complex congenital heart disease and central venous catheters.

• 5 of the 6 patients underwent palliative surgery, indicating high cardiac complexity.
• Common clinical features included fever, elevated C-reactive protein, elevated leukocytes, and use of respiratory support.
• Central venous catheters were present in all cases and identified as a potential risk factor.

Antibiotic therapy achieved blood-culture clearance in all 6 patients with probiotic-associated bacteremia.

• All 6 cases achieved resolution of bacteremia with antibiotic treatment.
• 1 death occurred among the 6 patients, attributed to underlying cardiac disease rather than the infection.
• Outcomes were described as correlating more with cardiac complexity than with bacteremia itself.

The authors recommend maintaining perioperative probiotic use while enhancing infection-control measures related to central line care.

• The recommendation to continue probiotics suggests the authors view the benefit-risk ratio as favorable given the rarity of bacteremia.
• Specific emphasis was placed on central line care as a target for infection-control improvements.
• The authors concluded probiotic-associated bacteremia is rare and usually resolves with antibiotics in this population.