LACTOBACILLUS BACTEREMIA AND ENDOCARDITIS - REVIEW OF 45 CASES

Lactobacilli are part of normal gastrointestinal and genitourinary flo ra but are an uncommon cause of bacteremia. We reviewed the cases of 4 5 patients with clinically significant lactobacillus bacteremia occurr ing over 15 years. Underlying conditions were common, including cancer (40%), recent surgery (38%), and diabetes mellitus (27%). Twenty-two patients were in the intensive care unit at the time of onset of lacto bacillus bacteremia. Eleven of the 45 patients were receiving immunosu ppressive therapy, 11 were receiving total parenteral nutrition, and 2 3 had received antibiotics without activity against Lactobacillus prio r to the occurrence of bacteremia. Bacteremia was polymicrobial in 27 patients and developed during hospitalization in 39. Thirty-one patien ts died, but only one death was attributable to lactobacillus bacterem ia. Lactobacilli are relatively avirulent pathogens that produce bacte remia in patients with serious underlying illnesses, many of whom have received prior antibiotic therapy that may select out for the organis m. While rarely fatal in itself, lactobacillus bacteremia identifies p atients with serious and rapidly fatal illness.