Contraindications for Bacillus clausii in Immunocompromised Patients

Evidence-Based Rationale

Probiotics should not be used in immunocompromised patients due to rare but serious risk of bacteremia, as recommended by the World Society of Emergency Surgery 1, 2
The World Society of Emergency Surgery explicitly states that probiotics are contraindicated for immunocompromised patients, citing the risk of bacteremia and sepsis 1, 2
Probiotics should not be administered to patients at risk of bacteremia or fungemia, according to guidelines from the World Society of Emergency Surgery 1, 2
The short-term use of probiotics appeared safe and effective only in patients who are not immunocompromised or severely debilitated, as reported in studies cited by the World Society of Emergency Surgery 1, 2

For immunocompromised patients with diarrhea or antibiotic-associated complications, standard antimicrobial therapy without probiotic supplementation is recommended, as suggested by the World Society of Emergency Surgery 1, 2
For recurrent C. difficile infection in mildly or moderately immunocompromised patients, conventional fecal microbiota transplant may be considered, but not B. clausii, according to guidelines from the American Gastroenterological Association 3, 4, 5, 6
For severely immunocompromised patients with recurrent C. difficile, avoid all fecal microbiota-based therapies and use extended or suppressive antibiotic therapy until immune recovery, as recommended by the American Gastroenterological Association 3, 4, 5, 7