Pediatr Infect Vaccine.  2017 Dec;24(3):168-177. 10.14776/piv.2017.24.3.168.

A Retrospective Analysis of Characteristics of Probiotics Associated with Invasive Bacterial Infections in Children

  • 1Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, the Republic of Korea.


The purpose of this study was to analyze the clinical features and risk factors of invasive infections caused by Lactobacillus spp. and Saccharomyces spp., components of commercially available probiotics.
We analyzed demographic and clinical data from children ≤18 years of age with an invasive infection caused by Lactobacillus spp. or Saccharomyces spp. at the Asan Medical Center Children's Hospital from January 1998 to June 2016. Probiotic consumption data were also analyzed.
During the study period, a total of 24 episodes of invasive infections were caused by Lactobacillus spp. (n=16) and Saccharomyces cerevisiae (n=8). Along with the increase of probiotic use (755,594 [days/1,000 patient-admission days] in 2001 to 2005, 1,444,066 in 2006 to 2010, and 6,904,736 in 2011 to 2016), the incidence of probiotic-associated invasive infection increased (R2=0.70). The median age of the patients was 1.8 years (range, 2 months to 17 years), and most of them had underlying medical conditions. The 30-day mortality rate was 20.8% (5/24), and 11 (45.8%) of these patients resulted from a severe invasive infection. We determined the risk factors for invasive infection to be: previous intensive care unit stay (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.5 to 6.1] and the presence of a central venous catheter (OR, 2.2; 95% CI, 1.2 to 4.3).
Although the probiotic-associated invasive infections rarely occurred in children, the incidence has increased along with probiotic pressure. Judicious use of probiotics is mandatory, especially in young children with underlying medical conditions and continuous surveillance will be needed to minimize the safety concerns.


Probiotics; Lactobacillus; Saccharomyces; Safety; Korea

MeSH Terms

Bacterial Infections*
Central Venous Catheters
Intensive Care Units
Retrospective Studies*
Risk Factors
Saccharomyces cerevisiae


  • Figure 1 Trend of probiotics usage and incidence of invasive infection of Lactobacillus spp. and Saccharomyces cerevisiae. (A) For 19 years from 1998 to 2016, 24 cases of invasive infection of Lactobacillus spp. and S. cerevisiae has occurred. (B) During recent 15 years, the incidence of invasive infection of Lactobacillus spp. and S. cerevisiae has increased significantly with increasing use of probiotics (R2=0.53 [Lactobacillus spp.], R2=0.39 [S. cerevisiae], R2=0.70 [total]; each P for trend <0.05). *Incidence of invasive infection is expressed as number of cases per year. †Probiotic consumption is expressed as days on the probiotics per 1,000 patient admission days per year.


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