Background

Necrotizing enterocolitis (NEC) is one of the most serious complications in preterm infants. Probiotics have been used to prevent NEC. Safety is a major concern for this practice.

Methods

We reported a female preterm infant who received oral Lactobacillus rhamnosus GG but developed sepsis 12 days after the treatment. Cultures of blood and the catheter tip yielded L. rhamnosus. Next-generation sequencing was performed to analyze isolates from blood, stool, catheter, and product capsules. We also determined the capacities of these isolates to form biofilms. A literature review was performed.

Results

The patient was treated with ampicillin and piperacillin/tazobactam, and she subsequently recovered without complications. The analysis of genome sequences indicated that all the isolates belonged to the clone of L. rhamnosus GG (ATCC 53103), suggesting that sepsis was a catheter-related infection caused by the oral probiotic. L. rhamnosus GG (ATCC 53103) and the probiotic strain tested formed biofilms under all growth conditions. Isolates from the blood and catheter tip also formed biofilms, but the stool isolate did not. The capacity of intrinsic biofilm formation in L. rhamnosus GG depended on environmental factors and the type of culture medium. Literature review of L. rhamnosus GG sepsis in preterm and young infants found that nearly 60% of the patients had a suspected or confirmed infected catheter.

Conclusion

The study showed that the capacity of L. rhamnosus GG to form biofilms, especially in the presence of glucose, is a critical factor leading to the probiotic-related sepsis in preterm infants.

中文翻译：

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与极早产儿益生菌治疗相关的鼠李糖乳杆菌败血症：发病机制和临床医生综述

背景

坏死性小肠结肠炎 (NEC) 是早产儿最严重的并发症之一。益生菌已被用于预防 NEC。安全是这种做法的主要问题。

方法

我们报告了一名接受口服鼠李糖乳杆菌GG 但在治疗后 12 天出现败血症的女性早产儿。血液和导管尖端的培养产生了鼠李糖乳杆菌。进行了下一代测序以分析来自血液、粪便、导管和产品胶囊的分离物。我们还确定了这些分离物形成生物膜的能力。进行了文献综述。

结果

该患者接受了氨苄西林和哌拉西林/他唑巴坦治疗，随后她康复，没有出现并发症。基因组序列分析表明，所有分离株均属于鼠李糖乳杆菌GG（ATCC 53103）的克隆，表明败血症是由口服益生菌引起的导管相关感染。L. rhamnosus GG (ATCC 53103) 和所测试的益生菌菌株在所有生长条件下都形成了生物膜。血液和导管尖端的分离物也形成了生物膜，但粪便分离物没有。L. rhamnosus GG内在生物膜形成的能力取决于环境因素和培养基类型。鼠李糖乳杆菌的文献综述 早产儿和小婴儿的 GG 败血症发现，近 60% 的患者有疑似或确诊感染的导管。

结论

研究表明，鼠李糖乳杆菌GG 形成生物膜的能力，尤其是在葡萄糖存在的情况下，是导致早产儿益生菌相关败血症的关键因素。