Probiotic Use in Vulnerable Populations

Introduction to Probiotic Precautions

Probiotics should not be administered to immunocompromised patients, those with damaged intestinal mucosa, critically ill patients, or patients at risk of bacteremia or fungemia due to the risk of serious adverse effects including sepsis 1, 2

Immunocompromised individuals, including patients with HIV/AIDS, those on immunosuppressive therapy, and transplant recipients, require careful evaluation before probiotic use 1
Critically ill patients, including those with severe acute pancreatitis and multiple organ failure, should be cautious with probiotic use due to increased mortality risk 1
Patients with compromised intestinal barrier, such as those with inflammatory bowel disease, liver disease, and leaky gut, should avoid probiotics 1
Other high-risk conditions, including premature infants, elderly patients with severe comorbidities, and patients with cardiac valvular disease, require careful consideration before probiotic use 1

Saccharomyces boulardii is contraindicated in patients at risk of fungemia and should be used with caution in patients with central venous catheters 1
Lactobacilli species can cause bacterial sepsis and should be avoided in patients with damaged intestinal mucosa 1, 2
High-dose probiotics require extra caution due to the higher risk of translocation in compromised patients 1

Probiotics may be considered for prevention of recurrent Clostridium difficile infection (CDI), but should not be used in immunocompromised patients even during CDI outbreaks 2
Probiotics should be avoided in severe active inflammatory bowel disease with mucosal damage and used with caution in patients with predicted severe acute pancreatitis 1

Ensure precise identity of bacteria at strain level and verify product contains stated number of viable organisms 1, 3
Consider potential contamination risks, such as the case of infant death from mold contamination in probiotic supplement 1, 3