A Case of Saccharomyces cerevisiae Fungemia in a Premature Infant treated with Probiotics

Background: Probiotics are live microorganisms that confer a health benefit on the host when administered in adequate amounts. Probiotics affect the intestinal ecosystem by impacting mucosal immune mechanisms. Enteral probiotics are commonly used in premature neonates with antibiotic associated diarrhea, necrotizing enterocolitis. Saccharomyces boulardii, a subtype of S. cerevisiae, is widely used as a biotherapeutic agent. However, fungemia with Saccharomyces cerevisiae can occur in weak and immunocompromised patients. We present the case of a premature infant in neonatal intensive care unit who was treated with probiotics and developed S. cerevisiae fungemia.

Case presentation: A Korean female infant with a birth weight of 1,560g was born at 29+3 weeks of gestation via cesarean section delivery. The patient had feeding intolerance and abdominal distension, requiring parenteral nutrition by a peripherally inserted central catheter. At the age of 37 days, we started on the infant twice-daily treatment with probiotics (Saccharomyces boulardii). After 14 days of receiving probiotics, the patient developed sepsis, and the Saccharomyces cerevisiae was isolated in peripheral blood cultures. We removed the contaminated central venous catheter and used a Fluconazole 10mg/kg/day. After antifungal treatment (fluconazole), the blood cultures were negative and the patient recovered clinically.

Conclusion: Probiotics containing S. boulardii are commonly used to treat many diseases. In neonates, we should be cautious about the indication of their use, preparation, and administration, particularly if a central intravenous catheter has been inserted.