Probiotic Lactobacill bacteria

Paul Auwaerter, M.D.  
Johns Hopkins

  • Rarely a human pathogen.
  • Isolation usually indicates a contaminant. If pathogen, has a low level of virulence unless comorbidities present.  
    Occasionally associated with polymicrobial bacteremia (often w/ streptococci, candida, gram negative enteric
  • Actual infection usually a marker of serious underlying disease, such as chronically ill, debilitated or
    immunosuppressed patients with overall mortality rate greater then 50% at 1 year.  
  • Liver transplantation with roux-en-y choledochojejunostomy is a major risk factor for infection.  
  • Selective bowel decontamination, especially with vancomycin another major risk factor for infection.  
  • Other risk factors include: abdominal surgery, HIV, transplantation, neoplasm, immunosuppression, diabetes,
    and valvular disease.  
  • Portals of entry include: GI Tract, oropharynx and female reproductive tract. No intravenous catheter related
    infections have been reported.

  • Dental: caries and periodontal abscesses.
  • Abscesses: intraabdominal, splenic, hepatic.
  • Bacteremia: frequently seen as part of polymicrobial process.
  • Endocarditis (rare): few reports of patients with abnormal valves, following dental manipulation.
  • Urinary tract infection: dominant organism of the female GU tract. Numbers usually fall with UTI or vaginal
    infection. May be a contaminant. Treat only with repeated isolation and appropriate symptoms.
  • Chorioamnionitis/endometriosis: seen postpartum as complication of delivery.
  • Meningitis: few case reports in neonates.

It would appear that even probiotic Lactobacill bacteria can and does pick up the necrotizing (flesh
eating) gene.

Letter to the Editor
Pancreatology 2005;5:594
DOI: 10.1159/000087502
Lactobacilli in Necrotizing Pancreatitis

M.G.H. Besselink a H.M. Timmerman a B.U. Ridwan b L.M.A. Akkermans a H.G. Gooszen a
Departments of a Surgery and b Microbiology, University Medical Center Utrecht and Dutch Acute Pancreatitis
Study Group, the Netherlands, Utrecht , The Netherlands Published online: August 16, 2005
Marc Besselink, MD, University Medical Center Utrecht, Heidelberglaan 100, HP G04.228
NL–3484 CX Utrecht (The Netherlands) Tel. +31 302 50 8074, Fax +31 302 54 1944, E-Mail m.besselink@umcutrecht.
nl © 2005 S. Karger AG, Basel and IAP
Accessible online at:

It is with interest that we read the case report by Dr. Z’Graggen et al. [1] regarding a patient with pancreatic infection
due to Lactobacillus paracasei . The topic is of special interest since a recent placebo-controlled trial demonstrated
that certain Lactobacillus strains (probiotics) can in fact reduce infections in patients with severe acute
pancreatitis [2] . It is hypothesized that probiotics reduce small bowel bacterial overgrowth and subsequent bacterial
translocation, thus preventing infectious complications. In the Netherlands, our study group is currently conducting a
multicenter placebo-controlled trial to validate these findings [3] . Lactobacillus paracasei subsp. tolerans is, to the
best of our best knowledge, not being used as a probiotic organism. It is felt that lactobacilli may indeed translocate
along with other commensal enteral organ-isms to pancreatic necrosis. However, for lactobacilli to cause a clinically
relevant infection is extremely rare as pointed out by Dr. Z’Graggen. This case is indeed remarkable since
Lactobacillus was the only bacterium cultured. It remains unknown whether the Lactobacillus caused the (presumed)
primary infection since no fi ne needle aspiration was performed in the initial admission. We wonder whether during
(planned) surgical debridement other bacterial flora was either cultured or detected by means of 16s DNA from the
(peri-)pancreatic necrosis. Furthermore we would like to comment that a patient with severe acute pancreatitis
can hardly be called ‘immunocompetent’; it is the severe immune suppression normally seen in the second phase of
acute pancreatitis that is causative for the infectious complications [4] .

Effect of biofilm culture on antibiotic susceptibility of lactobacilli causing endocarditis

J. Wynne Jones and S.N. Paull

Public Health Laboratory, Musgrove Park Hospital, Taunton, U.K.