# Case Series of Bacteremia Associated with Probiotic Use in Children after Cardiac Surgery, China

## TL;DR

A rare case series in China shows that probiotics used in children after heart surgery can cause blood infections, but these are usually treatable with antibiotics.

## Contribution

This study reports rare cases of probiotic-associated bacteremia in postoperative pediatric cardiac surgery patients in China.

## Key findings

- Probiotic-associated bacteremia occurred in six children, with three not directly receiving probiotics.
- All cases resolved with antibiotics, and outcomes were more linked to heart disease severity than the infection itself.
- The study recommends improved infection control, especially for central line care, to reduce risks.

## Abstract

We examined probiotic-associated bacteremia in a cohort of postoperative pediatric cardiac surgery patients in China. Among 16,436 children who underwent cardiac surgery during 2019–2024, a total of 5,034 received probiotics; 6 developed bacteremia with probiotic strains (Bacillus subtilis, Bacillus licheniformis, Lacticaseibacillus rhamnosus). Three cases occurred in children who had not directly received probiotics, suggesting potential cross-contamination or catheter-related transmission. All 6 patients had complex congenital heart disease and central venous catheters; 5 underwent palliative surgery. Fever, elevated C-reactive protein and leukocytes, and use of respiratory support were common. Antibiotic therapy achieved blood-culture clearance in all; 1 death occurred because of underlying cardiac disease, not infection. Our findings conclude probiotic-associated bacteremia is rare and usually resolves with antibiotics; outcomes correlate more with cardiac complexity than bacteremia itself. Maintaining perioperative probiotic use and enhancing infection-control measures, specifically regarding central line care, are recommended to minimize the risk for probiotic-associated bacteremia in pediatric cardiosurgical patients.