[Irritable bowel syndrome: dietary and pharmacological therapeutic options]

Probiotic-Associated Central Venous Catheter Bloodstream Infections Lead to Increased Mortality in the ICU

OBJECTIVES

To determine the occurrence rate and impact on patient outcomes of probiotic-associated central venous catheter bloodstream infections in the ICU.

DESIGN

Retrospective observational cohort study.

SETTING

The cohort was gathered using HCA Healthcare's data warehouse.

PATIENTS

Adult patients with central venous catheters in the ICU.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Blood culture data were used to determine whether an infection had occurred with an organism contained in an administered probiotic. Eighty-six probiotic-associated central venous catheter bloodstream infections were identified among the 23,015 patient cohort who received probiotics (0.37%). The number needed to harm was 270. Zero infections were found in the cohort that did not receive probiotics. Patients who contracted a probiotic infection had increased mortality (odds ratio, 2.23; 1.30-3.71; p < 0.01). Powder formulations had an increased rate of infection compared with nonpowder formulations (0.76% vs 0.33%; odds ratio, 2.03; 1.05-3.95; p = 0.04).

CONCLUSIONS

Probiotic administration is associated with a substantial rate of probiotic-associated bloodstream infection in ICU patients with central venous catheters in place. Probiotic-associated bloodstream infections result in significantly increased mortality. Powder formulations cause bloodstream infections more frequently than nonpowder formulations. In ICU patients with central venous catheters, the risks of probiotic-associated central venous catheter bloodstream infection and death outweigh any potential benefits of probiotic administration.

Does a self-management program change dietary intake in adults with irritable bowel syndrome?

Making dietary changes such as increasing fiber intake is recommended for the management of irritable bowel syndrome symptoms. Few studies have explored the efficacy of education on compliance with recommendations such as increasing fiber, vegetable, and fruit intake in adults with irritable bowel syndrome. This study examined the effect of a multicomponent self-management intervention that included strategies to enhance fiber, vegetable, and fruit intake. Participants with medically diagnosed irritable bowel syndrome were randomized to usual care or individualized comprehensive self-management, delivered either in-person or by telephone. Since previously published analyses show the two delivery modes to be equally effective, the two intervention groups were combined. Of the 188 individuals randomized, 173 participants (113 in the self-management group and 60 in the usual care group; 23 men, 150 women) provided data on at least one of the three follow-up occasions (3, 6, and 12 months postrandomization). Fiber, vegetable, and fruit intakes were measured using the Food Frequency Questionnaire. Participants in the intervention group demonstrated increases (p < .05) in fiber and fruit intake and a trend in vegetable intake at 6 and 12 months postintervention. Improvement in dietary fiber intake following a self-management intervention for IBS continues to 1 year.