ACCP Virtual Poster Symposium

1. Risk of lactobacillus infection in critically ill adults receiving lactobacillus probiotics. Zach Ruege, Pharm.D.; UGA College of Pharmacy, Augusta, GA INTRODUCTION: Probiotics have been advocated in critically ill patients to mitigate risk for developing Clostridium difficile infection and ventilator associated pneumonia. Critically ill patients display suppressed immune response of the intestinal mucosa and increased digestive tract permeability increasing the likelihood that probiotic bacteria may translocate into the blood and cause opportunistic infection in this population. RESEARCH QUESTION OR HYPOTHESIS: What is the incidence of lactobacillus infections in critically ill patients that were prescribed probiotics during their intensive care unit (ICU) stay? STUDY DESIGN: This study is a single-site, retrospective, nonrandomized, observational medication use evaluation from January 1st 2014 and December 17th 2015. Adults greater than 18 years of age admitted to an ICU who received at least one dose of Culturelle probiotic (Lactobacillus rhamnosus GG) were included. The primary endpoint was the incidence of culture positive lactobacillus infection following probiotic administration. Secondary endpoints included characterization of Culturelle use, patient risk factors for probiotic related infection, and clinical outcomes. METHODS: Medical records were reviewed to collect information regarding patient demography, past medical history, location of care, probiotic dosing, and clinical outcomes. Descriptive statistics were performed. RESULTS: A total of 77 critical care patients received at least one dose of Culturelle during the evaluation period. Before patients were administered their first dose, 10.4% had no risk factors, 16.9% displayed minor risk factors, and 72.7% presented with major risk factors to develop probiotic related infections. Four patients developed infections with positive cultures for Lactobacillus spp. while concurrently on Culturelle (5.16 percent). Of patients that received probiotics and treated in the Surgical ICU, 16.0 percent had a positive culture for Lactobacillus spp. Of those with positive cultures, there was a 50 percent in-house mortality rate. CONCLUSION: Careful risk benefit analysis should be made before administering probiotics to patients in ICU settings.