Send to

Choose Destination
Transpl Infect Dis. 2016 Oct;18(5):699-705. doi: 10.1111/tid.12587. Epub 2016 Sep 21.

Incidence and outcomes of bloodstream infections among hematopoietic cell transplant recipients from species commonly reported to be in over-the-counter probiotic formulations.

Author information

Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Department of Medicine, University of Washington, Seattle, Washington, USA.
Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Department of Medicine, University of Washington, Seattle, Washington, USA.
Infection Prevention, Seattle Cancer Care Alliance, Seattle, Washington, USA.



Probiotic supplementation has been promoted for numerous health conditions; however, safety in immunosuppressed patients is unknown. We evaluated bloodstream infections (BSIs) caused by common probiotic organisms in hematopoietic cell transplant recipients.


All blood culture (BC) results from a cohort of hematopoietic cell transplant recipients transplanted at Fred Hutchinson Cancer Research Center in Seattle, Washington, between 2002 and 2011 were reviewed. Patients with at least 1 positive BC for common probiotic organisms (Lactobacillus species, Bifidobacterium species, Streptococcus thermophilus, and Saccharomyces species) within 1 year post hematopoietic cell transplantation (HCT) were considered cases. Data were collected from center databases, which contain archived laboratory data, patient demographics, and clinical summaries.


A total of 19/3796 (0.5%) patients developed a BSI from one of these organisms within 1 year post HCT; no Bifidobacterium species or S. thermophilus were identified. Cases had a median age of 49 years (interquartile range [IQR]: 39-53), and the majority were allogeneic hematopoietic cell transplant recipients (14/19, 74%). Most positive BCs were Lactobacillus species (18/19) and occurred at a median of 84 days (IQR: 34-127) post transplant. The incidence rate of Lactobacillus bacteremia was 1.62 cases per 100,000 patient-days; the highest rate occurred within 100 days post transplant (3.3 per 100,000 patient-days). Eight patients (44%) were diagnosed with acute graft-versus-host disease of the gut prior to the development of bacteremia. No mortality was attributable to any of these infections.


Organisms frequently incorporated in available over-the-counter probiotics are infrequent causes of bacteremia after HCT. Studies evaluating the use of probiotics among high-risk patients are needed.


Lactobacillus ; bacteremia; fungemia; hematopoietic cell transplant; over-the-counter; probiotic

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center