• Users Online: 72
  • Print this page
  • Email this page

 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 5  |  Page : 234-242

Probiotics in critically ill children: An updated review

1 Department of Pediatrics, Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Pediatric Intensive Care, Zydus Hospitals, Ahmedabad, Gujarat, India

Date of Submission15-Aug-2021
Date of Decision29-Aug-2021
Date of Acceptance04-Sep-2021
Date of Web Publication28-Sep-2021

Correspondence Address:
Dr. Suresh Kumar Angurana
Department of Pediatrics, Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcc.jpcc_73_21

Rights and Permissions

Gut microbiome is a complex ecosystem where good microbes outnumber pathogenic bacteria. Gut microbiome plays important role in host biology, function, physiology, and immune response by performing nutritive and immune functions and by providing physical barriers against pathogenic microorganisms. Critical illness leads to disruption of the gut microbiome, colonization with and overgrowth of pathogenic microorganisms, translocation of pathogens and their toxins, systemic inflammatory response syndrome, and sepsis. Probiotics restore gut microbiome, improve the barrier function of gastrointestinal tract, and prevent bacterial translocation. Commonly used probiotics are Lactobacillus, Bifidobacterium, and Saccharomyces. Enteral administration of probiotics has been shown to reduce the rate of necrotizing enterocolitis, candida colonization, candidiasis, sepsis, feed intolerance, mortality, and duration of hospital stay among preterm infants; and ventilator-associated pneumonia and antibiotic-associated diarrhea in critically ill children. Few studies suggested that probiotics supplementation among critically ill children resulted in reduction in the rate of candida colonization and candidiasis; and modulation of inflammation. However, there are safety concerns with probiotics as there are few reports of bacteremia/sepsis and fungemia in immunocompromised cases. Further, well-designed multicentric studies are needed to give clear answers on the dose and duration of treatment, the effectiveness of a single or multiple strain of probiotics, risk-benefit potential, and cost-effectiveness in critically ill children.

Keywords: Gut, pediatric intensive care unit, probiotics

How to cite this article:
Angurana SK, Mehta A. Probiotics in critically ill children: An updated review. J Pediatr Crit Care 2021;8:234-42

How to cite this URL:
Angurana SK, Mehta A. Probiotics in critically ill children: An updated review. J Pediatr Crit Care [serial online] 2021 [cited 2021 Oct 26];8:234-42. Available from: http://www.jpcc.org.in/text.asp?2021/8/5/234/326870

  Introduction Top

Children admitted to pediatric intensive care units (PICUs) are at high risk to develop changes in gut microbiome leading to various infectious complications and adverse clinical outcomes.[1],[2],[3] Based on their actions and benefits, probiotics have the potential and capability to restore the gut microbiome and confer a health benefit to the host. In the recent past, the use of probiotics among critically ill adults and neonates has been shown to prevent several infectious complications. Recently, the role of probiotics has been demonstrated among children admitted to PICU in the prevention of candida infection, ventilator-associated pneumonia (VAP), and modulation of inflammation.[3],[4],[5],[6],[7],[8],[9] In this paper, we discuss the role of probiotics in children admitted to PICU in the light of accumulated evidence and areas for future research identified.

  Composition and Role of Gut Microbiome Top

Gut microbiome is community of microorganisms which reside in our gastrointestinal tract (GIT) and with whom we have developed a symbiotic relationship over the course of millions of years. The gut microbiome is an ecologically complex and diverse ecosystem wherein a delicate and fine balance between the intestinal microflora and the human host is essential for health. Under physiological conditions, the good or beneficial microorganisms outnumber potentially pathogenic microorganisms. These microorganisms live in symbiosis with the host and perform many beneficial functions. There are >10,000 species of microorganisms in the GIT with the estimated total number being more than 10 times the total number of eukaryotic cells in the human body.[3],[10] A normal gut microbiome of humans predominantly consists of obligate anaerobes (95%, consisting of Bifidobacterium, Fusobacterium, Clostridium, Peptostreptococcus, Eubacterium, and Bacteriodes) as well as facultative anaerobes (1%–10%, consisting of Lactobacillus, Streptococcus, Staphylococcus, Klebsiella,  Escherichia More Details coli, and Bacillus). The predominant microorganisms are Bifidobacterium and Lactobacillus. However, each individual has his own unique microbiome composition based on geographical location, dietary pattern, age, underlying disease conditions, stress, medications/antibiotic usage, and critical illness.[3] In healthy state, gut microbiome performs several beneficial and health-promoting functions. In addition, there is crosstalk between the gut and other organs (gut-organ axis including gut-lung axis, gut-kidney axis, and gut-brain axis). The functioning of the gut-organ axis is bidirectional and important for homeostasis. The gut microbiome is important contributor to the gut-organ axis.[11],[12] Various beneficial functions performed by the gut microbiome are enumerated in [Table 1].
Table 1: The beneficial actions exhibited by the gut microbiome

Click here to view

  Critical Illness and Effect on Gut Microbiome Top

The critical illness as well as its treatment creates a hostile environment in the gut leading to alterations in the gut microbiome and overgrowth of pathogenic microorganisms. The usage of broad-spectrum antibiotics, invasive catheters and lines, steroids, endotracheal intubation and invasive mechanical ventilation, H2 blockers, and immunosuppressants alter the gut microbiome and lead to a hostile environment in the gut. This is further compounded by multiple organ dysfunction syndrome (MODS), altered gut motility, malnutrition, burns, acid-base imbalance, osmolality, and outpouring of stress hormones.[2],[3]

During critical illness, there are disturbances in the composition and function of the gut microbiome (gut dysbiosis), alteration in the mucosal defense mechanisms, and overgrowth of potentially pathogenic microorganisms. Further, cell apoptosis, neutrophil activation, cytokine release, and disruption in epithelial tight junctions lead to loss of local colonization resistance, translocation of pathogenic microorganisms and their toxins across the gut mucosa into the bloodstream, and finally, systemic inflammatory response syndrome, sepsis, MODS, and mortality.[1],[2] Therefore, the GIT is labeled as the origin and promoter of healthcare-associated infections (HCAIs) and MODS (gut-derived sepsis or gut as motor of MODS).[1],[19],[20] Restoring the healthy gut microbiome with the extraneous supply of beneficial microorganisms (probiotics) is an attractive and effective option.

  Probiotics in Clinical Setting Top

Probiotics are defined by the joint working group of FAO/WHO as “live microbes which when administered in adequate amount confer health benefit to the host.”[21] Lactobacillus and Bifidobacterium are commonly used probiotics[22] [Table 2]. The commercially available probiotics preparations contain either single or multiple strains. The multiple strain probiotics may be having more benefits and are more effective than single strain as they may have synergistic functions of individual probiotic strains. Daily supplementation of >106–109 colony-forming units (CFUs) of probiotics is suggested to be the minimum therapeutic dose.[22],[23]
Table 2: Commonly used microorganisms as probiotics

Click here to view

The pre-requisites for probiotic strains include that they should be nonpathogenic; demonstrated to have several beneficial effects without any adverse effects or safety issues; retain adequate viability during storage, transport, and use; stable in gastric acid, and bile; and should be able to adhere to and colonize the gut mucosa.[3],[4],[22],[24]

  How Probiotics Act? Top

Probiotics exert beneficial clinical effects by restoring the composition of the gut microbiome, imparting colonization resistance, modulating the immune response, and preventing bacterial translocation.[4],[5],[25] Probiotics activate gut mucosal immunity, stimulate secretion of immunoglobulin A, promote phagocytosis, produce inhibitory substances (bacteriocins, organic acids, hydrogen peroxide), provide competition for nutrients and adhesion sites to pathogenic bacteria, inhibit the action of various toxins produced by pathogens; modulate immune response (innate and adaptive), exert trophic effect on GIT mucosa, stimulate proliferation and differentiation of normal mucosal epithelium, maintain mucosal barrier defenses, and ultimately, prevent bacterial translocation.[3],[4],[5],[22],[24]

  Probiotic Use in Critically Ill Children Top

Among critically ill children, probiotics have been evaluated for prevention and treatment of antibiotic associated diarrhea (AAD), necrotising enterocolitis (NEC), HCAIs, VAP, candida colonization, candiduria, candidiasis, and modulation of inflammation.

  Probiotics and Prevention of Nec Top

Hoyos et al.[26] demonstrated that oral supplementation with probiotics (L. acidophilus and B. infantis) lead to reduction in the rate of NEC among preterm neonates. Later on, it was demonstrated that supplementation with L. rhamnosus GG among preterm infants (for 7 days) was not effective in decreasing urinary tract infection, sepsis, and NEC.[27] Subsequently, many randomized controlled trials (RCTs) demonstrated that probiotic supplementation among preterm neonates resulted in reduction in rates of NEC.[28],[29] In a meta-analysis (24 trials) involving preterm neonates, Al Faleh et al.[30] demonstrated that administration of probiotics (containing Lactobacillus ± Bifidobacterium) prevented severe NEC and mortality. Recently, Morgan et al.[31] in a meta-analysis (63 trials with 15,712 preterm neonates) demonstrated that a combination of 1 Lactobacillus species and ≥1 Bifidobacterium species lead to a significant reduction in severe NEC, time to reach full enteral feeds, duration of hospitalization, and mortality (moderate-to-high-quality evidence).

  Probiotic and Prevention of AAD Top

The osmotic and invasive AAD is common complication noted in critically ill children admitted to PICU receiving broad-spectrum antibiotics. It occurs because of decrease in the population of beneficial microorganisms, overgrowth of pathogens, and disruption of the mucosal barrier.[32] Several meta-analyses have shown that probiotics were effective in reducing the rate of AAD in children.[33],[34],[35],[36],[37],[38] The commonly used probiotics were S. boulardii and Lactobacilli (alone or in combination). Guo et al.[39] in a recent Cochrane systematic review (33 studies, 6352 participants) demonstrated that administration of probiotics (Lactobacillus, Bifidobacterium, Bacillus, Lactococcus, Saccharomyces, or Streptococcus, alone or in combination) lead to reduction in the AAD incidence [probiotics 8% (259/3232) vs. control 19% (598/3120), moderate certainty evidence]. The authors also noted that high dose of probiotics (≥5 billion CFUs/day) was more efficacious than low dose (<5 billion CFUs/day) in reduction of the incidence of AAD. Furthermore, probiotics reduced the duration of diarrhea by almost one day (low certainty evidence).

  Probiotics and Prevention of Healthcare Associated Infections Top

Various studies evaluated probiotics for the prevention of HCAIs among critically ill adults and yielded mixed results. A meta-analysis (12 RCTs, n = 1546) involving critically ill adults demonstrated that administration of probiotics resulted in significant reduction in healthcare-associated pneumonia but no significant effect on the duration of ICU and hospital stay, and ICU and hospital mortality.[40] Another systematic review (8 RCTs; n = 999) demonstrated that probiotic supplementation in critically ill adults leads to no beneficial effect on the duration of ICU stay, rate of HCAIs, and ICU mortality.[41] Petrof et al.[42] conducted a systematic review (23 RCTs) and noted that probiotics supplementation leads to reduction in infectious complications among critically ill adults, VAP rates, and ICU mortality. However, there was no effect on hospital mortality, and duration of ICU and hospital stay. Manzanares et al.[43] in a meta-analysis (30 RCTs, n = 2972) demonstrated that probiotics supplementation resulted in significant reduction in the incidence of HCAIs and VAP; but no effect on mortality or duration of hospital stay. In a recent meta-analysis (14 studies, n = 1975), Su et al.[44] demonstrated that supplementation with probiotics leads to reduction in the incidence of VAP and shorter length of antibiotic usage for VAP but no effect on ICU mortality, duration of mechanical ventilation, duration of stay in ICU, or occurrence of diarrhea.

Among critically ill children, there are limited studies on this topic. Honeycutt et al.[45] in a RCT (n = 61), demonstrated that supplementation with L. rhamnosus to critically ill children did not result in reduction in the incidence of HCAIs. However, there was a statistically non-significant trend toward increase in the rate of HCAIs in the probiotics group (11 vs. 4) (P = 0.31). However, further studies did not substantiate these findings. Wang et al.[46] conducted an RCT involving critically ill full-term infants (n-100) and demonstrated that the administration of a multiple strain probiotic (Lacticaseibacillus casei, Lactobacillus acidophilus, Bacillus subtilis, and Enterococcus faecalis) for 8 days resulted in increased immune activity, lesser incidence of healthcare-associated pneumonia and MODS, and shorter duration of hospital stay. In another RCT, Banupriya et al.[9] enrolled children ≤12 years of age (n = 150) receiving mechanical ventilation and demonstrated that supplementation with a multi-strain probiotic preparation (L. acidophilus, L. rhamnosus, L. casei, L. plantaris, L. bulgaricus, B. longum, B. breve, B. infantis, and S. thermophilus) for 7 days resulted in decrease in VAP rate; and duration of PICU stay, hospital stay, and mechanical ventilation.

  Probiotics and Prevention of Candida Infection Top

Many RCTs have evaluated the effect of probiotic supplementation on the prevention of GIT candida colonization as well as invasive candidiasis among neonates. In an RCT conducted by Manzoni et al.[47] including 80 VLBW neonates, authors demonstrated that administration of L. rhamnosus resulted in reduction in the rate as well as the intensity of gut Candida colonization. Similarly, Romeo et al.[48] in an RCT (n = 249) demonstrated that supplementation with either L. reuteri or L. rhamnosus resulted in significant reduction in GIT Candida colonization, late-onset neonatal sepsis, and abnormal neurological state among preterm neonates. Demirel et al.[49] conducted an RCT including VLBW infants and demonstrated that the prophylactic administration of S. boulardii was effective in reducing fungal colonization as well as invasive fungal infections (similar to nystatin); and was more effective (compared to nystatin) in reducing the rates of sepsis and better feed tolerance. Roy et al.[50] conducted an RCT involving preterm neonates and noted that the probiotics supplementation (L. acidophilus, B. longum, B. bifidum and B. lactis) resulted in reduction in fungal colonization in gut, invasive fungal infection, early achievement of full enteral feeds, and reduction in length of hospital stay. In another RCT by Oncel et al.[51] involving preterm infants, it was demonstrated that administration of L. reuteri led to reduction in fungal colonization, invasive candidiasis, the incidence of sepsis, feeding intolerance, and duration of hospital stay. These effects were similar to that noted with nystatin. Recently, Hu et al.[52] in a meta-analysis (7 RCTs, n = 1371 preterm neonates) demonstrated that probiotic supplementation resulted in decrease in the rate of candida colonization and invasive fungal infections.

In critically ill children, few trials evaluated the role of multiple strains of probiotics in the reduction of Candida colonization and invasive Candidiasis. Our group conducted an RCT involving critically ill children on broad-spectrum antibiotics admitted in PICU and demonstrated that the administration of multiple strains of probiotics (L. acidophilus, L. rhamnosus, B. longum, B. bifidum, S. boulardi, and S. thermophilus) for 7 days resulted in significant decrease in GIT Candida colonization and candiduria; and nonsignificant decrease in the rates of Candidiasis.[8] Further, in a before-after study, we demonstrated that probiotic supplementation among children on broad-spectrum antibiotics in PICU resulted in significant decrease in the incidence of candiduria and invasive candidiasis.[7] To summarize, there is some evidence that probiotic supplementation could be a potential strategy in decreasing the rates of Candida colonization and candidiasis among critically ill children in PICU.

  Probiotics and Modulation of Inflammation Top

Various clinical studies and trials involving adults and children in health and disease states evaluated the potential role of probiotic supplementation on inflammation and other clinically important outcomes.[6],[53],[54],[55],[56],[57],[58],[59],[60] In a meta-analysis, Kazemi et al.[56] (167 clinical trials) included studies that evaluated the effect of probiotic or synbiotic supplementation (for a duration of >7 days) among healthy people and those with several disease conditions on inflammatory markers. Authors demonstrated that some of the probiotics resulted in reduction in C-reactive protein (CRP) among healthy individuals, in those with metabolic disorders, arthritis, and in critically ill; decrease in tumor necrosis factor (TNF)-α levels among healthy individuals, those with fatty liver, hepatic cirrhosis, and IBD; increased in interleukin-6 (IL-6) in renal failure and cirrhosis; and increased IL-10 in arthritis. Another meta-analysis (8 clinical trials, 1337 patients with diabetes) demonstrated that supplementation with probiotics resulted in significant decrease in CRP and TNF-α.[57] These meta-analyses suggested that probiotic supplementation in health and several disease states resulted in modulation of inflammation.[56],[57],[58]

In an RCT involving critically ill children with severe sepsis (n = 100), we demonstrated that supplementation of a probiotics mix for 7 days resulted in a significant reduction in the levels of pro-inflammatory (IL-6, IL-12p70, IL-17, and TNF-α) and increase in anti-inflammatory cytokines (IL-10 and TGF-β1).[6] Few other studies also noted that supplementation with probiotics was effective in the modulation of inflammation among critically ill.[59],[60]

  Probiotics and Coronavirus Disease 2019 Top

In COVID-19, the gut microbiome and bidirectional gut-lung interaction are important pathways that may be playing an important role. The higher severity of COVID-19 among young children and elderly and those with underlying co-morbid medical conditions is possibly due to less diversity of gut microbiome and gut dysbiosis in these cohorts of cases.[61],[62],[63],[64],[65],[66] In cases with COVID-19, it has been shown that there is the alteration in the gut microbiome, reduction in diversity and number of beneficial microorganisms, and increase in number and diversity of potentially pathogenic opportunistic microorganisms.[67],[68],[69] These changes in gut microbiome ultimately result in gut dysbiosis, mucosal barrier disruption, translocation of potentially pathogenic microorganisms across the gut mucosa, sepsis and bacterial infections, hyper-inflammatory response, and MODS, and increased mortality. The severe COVID-19 is perse characterized by hyper-inflammation, immune dysregulation, and cytokine storm. The levels of several cytokines are reported to be higher in cases with severe COVID-19 and among nonsurvivors.[69],[70],[71],[72],[73],[74],[75] Therefore, gut dysbiosis and the heightened or dysregulated inflammation are major pathways in cases with COVID-19 leading to increased severity of disease and poor outcomes.

By virtue of their actions, probiotics have the potential to have an impact at multiple steps in the cascade of COVID-19. Probiotics have antiviral actions,[76],[77],[78],[79],[80],[81],[82] they restore gut microbiome,[5],[6],[53],[54],[55],[83],[84],[85],[86],[87],[88] modulate inflammation/cytokine storm (anti-inflammatory),[6],[53],[54],[55],[56],[57],[58],[59],[60] and prevent secondary bacterial and fungal infections.[4],[7],[8],[43],[44],[89],[90],[91],[92],[93] In comparison to antiviral medications, immunomodulators, and other treatment strategies tested or used in COVID-19 patients, probiotics are easily available and easy to use (oral administration). Furthermore, they are safe and economical.[94] Therefore, probiotics by virtue of their beneficial effects maybe a useful strategy in the prevention of complications due to COVID-19.[95] The role of probiotics in moderate-to-severe COVID-19 needs to be tested. There are few ongoing studies that were designed to evaluate the effect of probiotics supplementation in cases with COVID-19 (NCT04368351, NCT04366180, and NCT04366089). In a recently published retrospective, observational cohort study, Ceccarelli et al.[96] enrolled adults (n = 200) with severe COVID-19 pneumonia. Authors compared the group that received the best available therapy (BAT) (n = 122) (low molecular-weight heparin plus ≥1 between azithromycin, hydroxychloroquine, antivirals, and Tocilizumab) with the group that received oral bacteriotherapy (n = 88) (Sivomixx® composed of S. thermophilus DSM 32245, B. lactis DSM 32246, B. lactis DSM 32247, L. acidophilus DSM 32241, L. helveticus DSM 32242, L. paracasei DSM 32243, L. plantarum DSM 32244, and L. brevis DSM 27961) in addition to BAT. The authors demonstrated that the mortality was lower in BAT plus oral bacteriotherapy group as compared to the BAT group (11% vs. 30%, P < 0.001). Further, oral bacteriotherapy was demonstrated to be an independent predictor for reduced risk for death.

  Probiotics and Safety Profile Top

Most of the available probiotic strains are usually safe in various settings, different age groups, and in critically ill. However, there are few concerning reports of lactobacillemia, liver abscess, and infective endocarditis, especially in immunosuppressed or severely debilitated patients.[3],[97],[98],[99],[100],[101],[102],[103] Although the risk of infection and sepsis due to Lactobacillus is very rare (0.05%–0.4%),[104] few reports of sepsis due to Lactobacillus (directly linked with the ingested probiotics), especially among immune-compromised cases raise safety concerns.[97] Rare reports of septicemia and fungemia due to S. boulardii in immunocompromised patients and critically ill are also documented.[105],[106],[107] B. longum bacteremia has been noted in preterm infants receiving probiotics.[108],[109] Despite these rare reports of adverse effects, probiotics are generally safe in wide range of settings including preterm neonates and critically ill children.[110],[111],[112] Other serious concerns are the genetic transfer of antibiotic resistance from probiotics strains to pathogenic microorganisms,[113],[114] immune stimulation, and harmful metabolic activities.[3],[4]

  Future Directions Top

Several studies demonstrated that probiotics have promising role in the prevention of various infectious complications in critically ill children in PICU. However, these studies have several limitations as most of these were single-center studies, had small sample sizes, involved different populations, and included children with variable disease conditions. The probiotics used, their dose and duration were different. Large multicentric well-designed trials are required to understand the efficacy and safety of probiotics in critically ill children in PICU. More information is needed on their mechanisms of action, optimal dose and duration, adverse events, risk-benefit potential, and whether single or multiple strain (combination) are more beneficial.

  Conclusions Top

Among critically ill children, the gut microbiome is altered which predisposes them to bacterial translocation, sepsis, MODS, and increased mortality. Probiotics have the potential to restore the balance of the intestinal microbiome. In critically ill children, probiotics supplementation has shown to reduce NEC, HCAIs, AAD, VAP, Candida colonization, candidiasis, and inflammation. The rare reports of bacteremia, fungemia, and sepsis due to probiotics in critically ill fragile patients raise safety concerns. Further, well-designed studies are needed before the routine use of probiotic supplementation could be recommended in critically ill children.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Marshall JC, Christou NV, Meakins JL. The gastrointestinal tract. The “undrained abscess” of multiple organ failure. Ann Surg 1993;218:111-9.  Back to cited text no. 1
Alverdy JC, Laughlin RS, Wu L. Influence of the critically ill state on host-pathogen interactions within the intestine: Gut-derived sepsis redefined. Crit Care Med 2003;31:598-607.  Back to cited text no. 2
Singhi SC, Baranwal A. Probiotic use in the critically ill. Indian J Pediatr 2008;75:621-7.  Back to cited text no. 3
Kumar S, Singhi S. Role of probiotics in prevention of Candida infection in critically ill children. Mycoses 2013;56:204-11.  Back to cited text no. 4
Singhi SC, Kumar S. Probiotics in critically ill children. F1000Res 2016;5:v1000-407.  Back to cited text no. 5
Angurana SK, Bansal A, Singhi S, Aggarwal R, Jayashree M, Salaria M, et al. Evaluation of effect of probiotics on cytokine levels in critically ill children with severe sepsis: A double-blind, placebo-controlled trial. Crit Care Med 2018;46:1656-64.  Back to cited text no. 6
Kumar S, Singhi S, Chakrabarti A, Bansal A, Jayashree M. Probiotic use and prevalence of candidemia and candiduria in a PICU. Pediatr Crit Care Med 2013;14:e409-15.  Back to cited text no. 7
Kumar S, Bansal A, Chakrabarti A, Singhi S. Evaluation of efficacy of probiotics in prevention of Candida colonization in a PICU-a randomized controlled trial. Crit Care Med 2013;41:565-72.  Back to cited text no. 8
Banupriya B, Biswal N, Srinivasaraghavan R, Narayanan P, Mandal J. Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: An open-label randomized controlled trial. Intensive Care Med 2015;41:677-85.  Back to cited text no. 9
Guarner F, Malagelada JR. Gut flora in health and disease. Lancet 2003;361:512-9.  Back to cited text no. 10
Tan JY, Tang YC, Huang J. Gut microbiota and lung injury. Adv Exp Med Biol 2020;1238:55-72.  Back to cited text no. 11
Zhang D, Li S, Wang N, Tan HY, Zhang Z, Feng Y. The cross-talk between gut microbiota and lungs in common lung diseases. Front Microbiol 2020;11:301.  Back to cited text no. 12
Corr SC, Li Y, Riedel CU, O'Toole PW, Hill C, Gahan CG. Bacteriocin production as a mechanism for the antiinfective activity of Lactobacillus salivarius UCC118. Proc Natl Acad Sci U S A 2007;104:7617-21.  Back to cited text no. 13
Roberfroid MB, Bornet F, Bouley C, Cummings JH. Colonic microflora: Nutrition and health. Summary and conclusions of an International Life Sciences Institute (ILSI) [Europe] workshop held in Barcelona, Spain. Nutr Rev 1995;53:127-30.  Back to cited text no. 14
Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.  Back to cited text no. 15
Younes H, Coudray C, Bellanger J, Demigné C, Rayssiguier Y, Rémésy C. Effects of two fermentable carbohydrates (inulin and resistant starch) and their combination on calcium and magnesium balance in rats. Br J Nutr 2001;86:479-85.  Back to cited text no. 16
Noverr MC, Huffnagle GB. The 'microflora hypothesis' of allergic diseases. Clin Exp Allergy 2005;35:1511-20.  Back to cited text no. 17
Weinstein PD, Cebra JJ. The preference for switching to IgA expression by Peyer's patch germinal center B cells is likely due to the intrinsic influence of their microenvironment. J Immunol 1991;147:4126-35.  Back to cited text no. 18
MacFie J, O'Boyle C, Mitchell CJ, Buckley PM, Johnstone D, Sudworth P. Gut origin of sepsis: A prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity. Gut 1999;45:223-8.  Back to cited text no. 19
Klingensmith NJ, Coopersmith CM. The gut as the motor of multiple organ dysfunction in critical illness. Crit Care Clin 2016;32:203-12.  Back to cited text no. 20
Lilly DM, Stillwell RH. Probiotics: Growth-promoting factors produced by microorganisms. Science 1965;147:747-8.  Back to cited text no. 21
Kligler B, Cohrssen A. Probiotics. Am Fam Physician 2008;78:1073-8.  Back to cited text no. 22
Bengmark S. Bioecologic control of the gastrointestinal tract: The role of flora and supplemented probiotics and synbiotics. Gastroenterol Clin North Am 2005;34:413-36, viii.  Back to cited text no. 23
Vandenplas Y, Huys G, Daube G. Probiotics: An update. J Pediatr (Rio J) 2015;91:6-21.  Back to cited text no. 24
Chermesh I, Eliakim R. Probiotics and the gastrointestinal tract: Where are we in 2005? World J Gastroenterol 2006;12:853-7.  Back to cited text no. 25
Hoyos AB. Reduced incidence of necrotizing enterocolitis associated with enteral administration of Lactobacillus acidophilus and Bifidobacterium infantis to neonates in an intensive care unit. Int J Infect Dis 1999;3:197-202.  Back to cited text no. 26
Dani C, Biadaioli R, Bertini G, Martelli E, Rubaltelli FF. Probiotics feeding in prevention of urinary tract infection, bacterial sepsis and necrotizing enterocolitis in preterm infants. A prospective double-blind study. Biol Neonate 2002;82:103-8.  Back to cited text no. 27
Lin HC, Su BH, Chen AC, Lin TW, Tsai CH, Yeh TF, et al. Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2005;115:1-4.  Back to cited text no. 28
Bin-Nun A, Bromiker R, Wilschanski M, Kaplan M, Rudensky B, Caplan M, et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates. J Pediatr 2005;147:192-6.  Back to cited text no. 29
AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2014:CD005496. doi: 10.1002/14651858.CD005496.pub4. Update in: Cochrane Database Syst Rev. 2020 Oct 15;10:CD005496. PMID: 24723255.  Back to cited text no. 30
Morgan RL, Preidis GA, Kashyap PC, Weizman AV, Sadeghirad B, McMaster Probiotic, Prebiotic, and Synbiotic Work Group. Probiotics reduce mortality and morbidity in preterm, low-birth-weight infants: A systematic review and network meta-analysis of randomized trials. Gastroenterology 2020;159:467-80.  Back to cited text no. 31
Beaugerie L, Petit JC. Microbial-gut interactions in health and disease. Antibiotic-associated diarrhoea. Best Pract Res Clin Gastroenterol 2004;18:337-52.  Back to cited text no. 32
D'Souza AL, Rajkumar C, Cooke J, Bulpitt CJ. Probiotics in prevention of antibiotic associated diarrhoea: Meta-analysis. BMJ 2002;324:1361.  Back to cited text no. 33
Szajewska H, Ruszczyński M, Radzikowski A. Probiotics in the prevention of antibiotic-associated diarrhea in children: A meta-analysis of randomized controlled trials. J Pediatr 2006;149:367-72.  Back to cited text no. 34
Johnston BC, Supina AL, Vohra S. Probiotics for pediatric antibiotic-associated diarrhea: A meta-analysis of randomized placebo-controlled trials. CMAJ 2006;175:377-83.  Back to cited text no. 35
Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: A systematic review and meta-analysis. JAMA 2012;307:1959-69.  Back to cited text no. 36
Szajewska H, Kołodziej M. Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2015;42:793-801.  Back to cited text no. 37
Szajewska H, Kołodziej M. Systematic review with meta-analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic-associated diarrhoea in children and adults. Aliment Pharmacol Ther 2015;42:1149-57.  Back to cited text no. 38
Guo Q, Goldenberg JZ, Humphrey C, El Dib R, Johnston BC. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 2019;4:CD004827.  Back to cited text no. 39
Liu KX, Zhu YG, Zhang J, Tao LL, Lee JW, Wang XD, et al. Probiotics' effects on the incidence of nosocomial pneumonia in critically ill patients: A systematic review and meta-analysis. Crit Care 2012;16:R109.  Back to cited text no. 40
Watkinson PJ, Barber VS, Dark P, Young JD. The use of pre- pro- and synbiotics in adult intensive care unit patients: Systematic review. Clin Nutr 2007;26:182-92.  Back to cited text no. 41
Petrof EO, Dhaliwal R, Manzanares W, Johnstone J, Cook D, Heyland DK. Probiotics in the critically ill: A systematic review of the randomized trial evidence. Crit Care Med 2012;40:3290-302.  Back to cited text no. 42
Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: A systematic review and meta-analysis. Crit Care 2016;19:262.  Back to cited text no. 43
Su M, Jia Y, Li Y, Zhou D, Jia J. Probiotics for the prevention of ventilator-associated pneumonia: A meta-analysis of randomized controlled trials. Respir Care 2020;65:673-85.  Back to cited text no. 44
Honeycutt TC, El Khashab M, Wardrop RM 3rd, McNeal-Trice K, Honeycutt AL, Christy CG, et al. Probiotic administration and the incidence of nosocomial infection in pediatric intensive care: A randomized placebo-controlled trial. Pediatr Crit Care Med 2007;8:452-8.  Back to cited text no. 45
Wang Y, Gao L, Zhang YH, Shi CS, Ren CM. Efficacy of probiotic therapy in full-term infants with critical illness. Asia Pac J Clin Nutr 2014;23:575-80.  Back to cited text no. 46
Manzoni P, Mostert M, Leonessa ML, Priolo C, Farina D, Monetti C, et al. Oral supplementation with Lactobacillus casei subspecies rhamnosus prevents enteric colonization by Candida species in preterm neonates: A randomized study. Clin Infect Dis 2006;42:1735-42.  Back to cited text no. 47
Romeo MG, Romeo DM, Trovato L, Oliveri S, Palermo F, Cota F, et al. Role of probiotics in the prevention of the enteric colonization by Candida in preterm newborns: Incidence of late-onset sepsis and neurological outcome. J Perinatol 2011;31:63-9.  Back to cited text no. 48
Demirel G, Celik IH, Erdeve O, Saygan S, Dilmen U, Canpolat FE. Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants. Eur J Pediatr 2013;172:1321-6.  Back to cited text no. 49
Roy A, Chaudhuri J, Sarkar D, Ghosh P, Chakraborty S. Role of enteric supplementation of probiotics on late-onset sepsis by Candida species in preterm low birth weight neonates: A randomized, double blind, placebo-controlled trial. N Am J Med Sci 2014;6:50-7.  Back to cited text no. 50
Oncel MY, Arayici S, Sari FN, Simsek GK, Yurttutan S, Erdeve O, et al. Comparison of Lactobacillus reuteri and nystatin prophylaxis on Candida colonization and infection in very low birth weight infants. J Matern Fetal Neonatal Med 2015;28:1790-4.  Back to cited text no. 51
Hu HJ, Zhang GQ, Zhang Q, Shakya S, Li ZY. Probiotics prevent Candida colonization and invasive fungal sepsis in preterm neonates: A systematic review and meta-analysis of randomized controlled trials. Pediatr Neonatol 2017;58:103-10.  Back to cited text no. 52
Cui LH, Wang XH, Peng LH, Yu L, Yang YS. The effects of early enteral nutrition with addition of probiotics on the prognosis of patients suffering from severe acute pancreatitis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2013;25:224-8.  Back to cited text no. 53
McNaught CE, Woodcock NP, Anderson AD, MacFie J. A prospective randomised trial of probiotics in critically ill patients. Clin Nutr 2005;24:211-9.  Back to cited text no. 54
Sanaie S, Ebrahimi-Mameghani M, Hamishehkar H, Mojtahedzadeh M, Mahmoodpoor A. Effect of a multispecies probiotic on inflammatory markers in critically ill patients: A randomized, double-blind, placebo-controlled trial. J Res Med Sci 2014;19:827-33.  Back to cited text no. 55
Kazemi A, Soltani S, Ghorabi S, Keshtkar A, Daneshzad E, Nasri F, et al. Effect of probiotic and synbiotic supplementation on inflammatory markers in health and disease status: A systematic review and meta-analysis of clinical trials. Clin Nutr 2020;39:789-819.  Back to cited text no. 56
Tabrizi R, Ostadmohammadi V, Lankarani KB, Akbari M, Akbari H, Vakili S, et al. The effects of probiotic and synbiotic supplementation on inflammatory markers among patients with diabetes: A systematic review and meta-analysis of randomized controlled trials. Eur J Pharmacol 2019;852:254-64.  Back to cited text no. 57
Milajerdi A, Mousavi SM, Sadeghi A, Salari-Moghaddam A, Parohan M, Larijani B, et al. The effect of probiotics on inflammatory biomarkers: A meta-analysis of randomized clinical trials. Eur J Nutr 2020;59:633-49.  Back to cited text no. 58
Wang G, Wen J, Xu L, Zhou S, Gong M, Wen P, et al. Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis. J Surg Res 2013;183:592-7.  Back to cited text no. 59
Timmerman HM, Niers LE, Ridwan BU, Koning CJ, Mulder L, Akkermans LM, et al. Design of a multispecies probiotic mixture to prevent infectious complications in critically ill patients. Clin Nutr 2007;26:450-9.  Back to cited text no. 60
Salazar N, Arboleya S, Valdés L, Stanton C, Ross P, Ruiz L, et al. The human intestinal microbiome at extreme ages of life. Dietary intervention as a way to counteract alterations. Front Genet 2014;5:406.  Back to cited text no. 61
Quercia S, Candela M, Giuliani C, Turroni S, Luiselli D, Rampelli S, et al. From lifetime to evolution: Timescales of human gut microbiota adaptation. Front Microbiol 2014;5:587.  Back to cited text no. 62
Deering KE, Devine A, O'Sullivan TA, Lo J, Boyce MC, Christophersen CT. Characterizing the composition of the pediatric gut microbiome: A systematic review. Nutrients 2019;12:E16.  Back to cited text no. 63
Elena RM, Gabriela GD, Arnulfo GC, Enrique CA. Studying the gut microbiome of Latin America and Hispanic/Latino populations. Insight into obesity and diabetes: Systematic review. Curr Diabetes Rev 2019;15:294-301.  Back to cited text no. 64
Patel NA. Pediatric COVID-19: Systematic review of the literature. Am J Otolaryngol 2020;41:102573.  Back to cited text no. 65
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.  Back to cited text no. 66
Gu S, Chen Y, Wu Z, Chen Y, Gao H, Lv L, et al. Alterations of the gut microbiota in patients with coronavirus disease 2019 or H1N1 influenza. Clin Infect Dis 2020;71:2669-78.  Back to cited text no. 67
Zuo T, Zhang F, Lui GC, Yeoh YK, Li AY, Zhan H, et al. Alterations in gut microbiota of patients with COVID-19 during time of hospitalization. Gastroenterology 2020;159:944-55.e8.  Back to cited text no. 68
Dhar D, Mohanty A. Gut microbiota and Covid-19- possible link and implications. Virus Res 2020;285:198018.  Back to cited text no. 69
Liu J, Li S, Liu J, Liang B, Wang X, Wang H, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine 2020;55:102763.  Back to cited text no. 70
Wang J, Jiang M, Chen X, Montaner LJ. Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: Review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts. J Leukoc Biol 2020;108:17-41.  Back to cited text no. 71
Wu H, Zhu H, Yuan C, Yao C, Luo W, Shen X, et al. Clinical and immune features of hospitalized pediatric patients with coronavirus disease 2019 (COVID-19) in Wuhan, China. JAMA Netw Open 2020;3:e2010895.  Back to cited text no. 72
Soy M, Keser G, Atagündüz P, Tabak F, Atagündüz I, Kayhan S. Cytokine storm in COVID-19: Pathogenesis and overview of anti-inflammatory agents used in treatment. Clin Rheumatol 2020;39:2085-94.  Back to cited text no. 73
Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, et al. Pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): A multicentre cohort. Ann Rheum Dis. 2020;79:999-1006.  Back to cited text no. 74
Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020;324:259-69.  Back to cited text no. 75
Anwar F, Altayb HN, Al-Abbasi FA, Al-Malki AL, Kamal MA, Kumar V. Antiviral effects of probiotic metabolites on COVID-19. J Biomol Struct Dyn 2021;39:4175-84.  Back to cited text no. 76
Eguchi K, Fujitani N, Nakagawa H, Miyazaki T. Prevention of respiratory syncytial virus infection with probiotic lactic acid bacterium Lactobacillus gasseri SBT2055. Sci Rep 2019;9:4812.  Back to cited text no. 77
Tonetti FR, Islam MA, Vizoso-Pinto MG, Takahashi H, Kitazawa H, Villena J. Nasal priming with immunobiotic lactobacilli improves the adaptive immune response against influenza virus. Int Immunopharmacol 2020;78:106115.  Back to cited text no. 78
Zelaya H, Tada A, Vizoso-Pinto MG, Salva S, Kanmani P, Agüero G, et al. Nasal priming with immunobiotic Lactobacillus rhamnosus modulates inflammation-coagulation interactions and reduces influenza virus-associated pulmonary damage. Inflamm Res 2015;64:589-602.  Back to cited text no. 79
Tomosada Y, Chiba E, Zelaya H, Takahashi T, Tsukida K, Kitazawa H, et al. Nasally administered Lactobacillus rhamnosus strains differentially modulate respiratory antiviral immune responses and induce protection against respiratory syncytial virus infection. BMC Immunol 2013;14:40.  Back to cited text no. 80
Kobayashi H, Kanmani P, Ishizuka T, Miyazaki A, Soma J, Albarracin L, et al. Development of an in vitro immunobiotic evaluation system against rotavirus infection in bovine intestinal epitheliocytes. Benef Microbes 2017;8:309-21.  Back to cited text no. 81
Zelaya H, Alvarez S, Kitazawa H, Villena J. Respiratory antiviral immunity and immunobiotics: Beneficial effects on inflammation-coagulation interaction during influenza virus infection. Front Immunol 2016;7:633.  Back to cited text no. 82
Arribas B, Rodríguez-Cabezas ME, Comalada M, Bailón E, Camuesco D, Olivares M, et al. Evaluation of the preventative effects exerted by Lactobacillus fermentum in an experimental model of septic shock induced in mice. Br J Nutr 2009;101:51-8.  Back to cited text no. 83
D'Souza A, Cai CL, Kumar D, Cai F, Fordjour L, Ahmad A, et al. Cytokines and Toll-like receptor signaling pathways in the terminal ileum of hypoxic/hyperoxic neonatal rats: Benefits of probiotics supplementation. Am J Transl Res 2012;4:187-97.  Back to cited text no. 84
Khailova L, Petrie B, Baird CH, Dominguez Rieg JA, Wischmeyer PE. Lactobacillus rhamnosus GG and Bifidobacterium longum attenuate lung injury and inflammatory response in experimental sepsis. PLoS One 2014;9:e97861.  Back to cited text no. 85
Arribas B, Garrido-Mesa N, Perán L, Camuesco D, Comalada M, Bailón E, et al. The immunomodulatory properties of viable Lactobacillus salivarius ssp. salivarius CECT5713 are not restricted to the large intestine. Eur J Nutr 2012;51:365-74.  Back to cited text no. 86
Papoff P, Ceccarelli G, d'Ettorre G, Cerasaro C, Caresta E, Midulla F, et al. Gut microbial translocation in critically ill children and effects of supplementation with pre- and pro biotics. Int J Microbiol 2012;2012:151393.  Back to cited text no. 87
Haak BW, Prescott HC, Wiersinga WJ. Therapeutic potential of the gut microbiota in the prevention and treatment of sepsis. Front Immunol 2018;9:2042.  Back to cited text no. 88
Goldenberg JZ, Ma SS, Saxton JD, Martzen MR, Vandvik PO, Thorlund K, et al. Probiotics for the prevention of Clostridium difficile – Associated diarrhea in adults and children. Cochrane Database Syst Rev. 2013;:CD006095. doi: 10.1002/14651858.CD006095.pub3. Update in: Cochrane Database Syst Rev. 2017 Dec 19;12 :CD006095. PMID: 23728658.  Back to cited text no. 89
Shen NT, Maw A, Tmanova LL, Pino A, Ancy K, Crawford CV, et al. Timely use of probiotics in hospitalized adults prevents Clostridium difficile infection: A systematic review with meta-regression analysis. Gastroenterology 2017;152:1889-900.e9.  Back to cited text no. 90
van Ruissen MC, Bos LD, Dickson RP, Dondorp AM, Schultsz C, Schultz MJ. Manipulation of the microbiome in critical illness-probiotics as a preventive measure against ventilator-associated pneumonia. Intensive Care Med Exp 2019;7:37.  Back to cited text no. 91
Bo L, Li J, Tao T, Bai Y, Ye X, Hotchkiss RS, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014;10:CD009066. doi: 10.1002/14651858.CD009066.pub2. PMID: 25344083; PMCID: PMC4283465.  Back to cited text no. 92
Yang Z, Wu Q, Liu Y, Fan D. Effect of perioperative probiotics and synbiotics on postoperative infections after gastrointestinal surgery: A systematic review with meta-analysis. JPEN J Parenter Enteral Nutr 2017;41:1051-62.  Back to cited text no. 93
Infusino F, Marazzato M, Mancone M, Fedele F, Mastroianni CM, Severino P, et al. Diet supplementation, probiotics, and nutraceuticals in SARS-CoV-2 infection: A scoping review. Nutrients 2020;12:E1718.  Back to cited text no. 94
Angurana SK, Bansal A. Probiotics and COVID-19: Think about the link. Br J Nutr. 2020:1-7. doi: 10.1017/S000711452000361X. Epub ahead of print. PMID: 32921328; PMCID: PMC8387695.  Back to cited text no. 95
Ceccarelli G, Borrazzo C, Pinacchio C, Santinelli L, Innocenti GP, Cavallari EN, et al. Oral bacteriotherapy in patients with COVID-19: A retrospective cohort study. Front Nutr 2020;7:613928.  Back to cited text no. 96
Cannon JP, Lee TA, Bolanos JT, Danziger LH. Pathogenic relevance of Lactobacillus: A retrospective review of over 200 cases. Eur J Clin Microbiol Infect Dis 2005;24:31-40.  Back to cited text no. 97
Rautio M, Jousimies-Somer H, Kauma H, Pietarinen I, Saxelin M, Tynkkynen S, et al. Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG. Clin Infect Dis 1999;28:1159-60.  Back to cited text no. 98
Horwitch CA, Furseth HA, Larson AM, Jones TL, Olliffe JF, Spach DH. Lactobacillemia in three patients with AIDS. Clin Infect Dis 1995;21:1460-2.  Back to cited text no. 99
Mackay AD, Taylor MB, Kibbler CC, Hamilton-Miller JM. Lactobacillus endocarditis caused by a probiotic organism. Clin Microbiol Infect 1999;5:290-2.  Back to cited text no. 100
Salminen MK, Rautelin H, Tynkkynen S, Poussa T, Saxelin M, Valtonen V, et al. Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG. Clin Infect Dis 2004;38:62-9.  Back to cited text no. 101
Salvana EM, Frank M. Lactobacillus endocarditis: Case report and review of cases reported since 1992. J Infect 2006;53:e5-10.  Back to cited text no. 102
Vahabnezhad E, Mochon AB, Wozniak LJ, Ziring DA. Lactobacillus bacteremia associated with probiotic use in a pediatric patient with ulcerative colitis. J Clin Gastroenterol 2013;47:437-9.  Back to cited text no. 103
Salminen MK, Tynkkynen S, Rautelin H, Saxelin M, Vaara M, Ruutu P, et al. Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland. Clin Infect Dis 2002;35:1155-60.  Back to cited text no. 104
Hennequin C, Kauffmann-Lacroix C, Jobert A, Viard JP, Ricour C, Jacquemin JL, et al. Possible role of catheters in Saccharomyces boulardii fungemia. Eur J Clin Microbiol Infect Dis 2000;19:16-20.  Back to cited text no. 105
Lestin F, Pertschy A, Rimek D. Fungemia after oral treatment with Saccharomyces boulardii in a patient with multiple comorbidities. Dtsch Med Wochenschr 2003;128:2531-3.  Back to cited text no. 106
Muñoz P, Bouza E, Cuenca-Estrella M, Eiros JM, Pérez MJ, Sánchez-Somolinos M, et al. Saccharomyces cerevisiae fungemia: An emerging infectious disease. Clin Infect Dis 2005;40:1625-34.  Back to cited text no. 107
Bertelli C, Pillonel T, Torregrossa A, Prod'hom G, Fischer CJ, Greub G, et al. Bifidobacterium longum bacteremia in preterm infants receiving probiotics. Clin Infect Dis 2015;60:924-7.  Back to cited text no. 108
Zbinden A, Zbinden R, Berger C, Arlettaz R. Case series of Bifidobacterium longum bacteremia in three preterm infants on probiotic therapy. Neonatology 2015;107:56-9.  Back to cited text no. 109
Manzoni P, Lista G, Gallo E, Marangione P, Priolo C, Fontana P, et al. Routine Lactobacillus rhamnosus GG administration in VLBW infants: A retrospective, 6-year cohort study. Early Hum Dev 2011;87 Suppl 1:S35-8.  Back to cited text no. 110
Srinivasan R, Meyer R, Padmanabhan R, Britto J. Clinical safety of Lactobacillus casei shirota as a probiotic in critically ill children. J Pediatr Gastroenterol Nutr 2006;42:171-3.  Back to cited text no. 111
Simakachorn N, Bibiloni R, Yimyaem P, Tongpenyai Y, Varavithaya W, Grathwohl D, et al. Tolerance, safety, and effect on the faecal microbiota of an enteral formula supplemented with pre- and probiotics in critically ill children. J Pediatr Gastroenterol Nutr 2011;53:174-81.  Back to cited text no. 112
Egervärn M, Danielsen M, Roos S, Lindmark H, Lindgren S. Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum. J Food Prot 2007;70:412-8.  Back to cited text no. 113
Egervärn M, Roos S, Lindmark H. Identification and characterization of antibiotic resistance genes in Lactobacillus reuteri and Lactobacillus plantarum. J Appl Microbiol 2009;107:1658-68.  Back to cited text no. 114


  [Table 1], [Table 2]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Composition and ...
Critical Illness...
Probiotics in Cl...
How Probiotics Act?
Probiotic Use in...
Probiotics and P...
Probiotics and P...
Probiotics and P...
Probiotics and M...
Probiotics and C...
Probiotics and S...
Future Directions
Probiotic and Pr...
Article Tables

 Article Access Statistics
    PDF Downloaded29    
    Comments [Add]    

Recommend this journal