Probiotic-related bacteremia after major hepatectomy for biliary cancer: a report of two cases

Surgical Case Reports

Masamichi Mizuma¹  Kei Nakagawa¹  Shuichi Aoki¹  Takashi Kamei¹  Mitsuhiro Shimura¹  Kei Kawaguchi¹  Tatsuyuki Takadate¹  Takayuki Miura¹  Kunihiro Masuda¹  Kyohei Ariake¹  Takanori Morikawa¹  Michiaki Unno¹  Shimpei Maeda¹  Masaharu Ishida¹  Hideo Ohtsuka¹ 

[1] Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, 980-8574, Sendai, Japan;

关键词: Probiotics;    Bacteremia;    Sepsis;    Postoperative complication;    Clostridium butyricum;   

DOI  :  10.1186/s40792-021-01216-5

来源: Springer

【 摘 要 】

BackgroundProbiotics have been reported to be beneficial for the prevention of postoperative complications and are often used during the perioperative period. Among the probiotic-related adverse events, bacteremia is rare. Here, we report two cases of probiotic-related bacteremia after major hepatectomy for biliary cancer.Case presentation 1A 74-year-old man was referred to our hospital to be treated for gallbladder cancer. Neoadjuvant chemotherapy, two courses of gemcitabine plus S-1 combination therapy, was administered. Extended right hepatectomy with caudate lobectomy, extrahepatic bile duct resection and biliary reconstruction were performed 3 weeks after chemotherapy. Probiotics, Clostridium butyricum (C. butyricum) MIYAIRI 588, were administered 6 days before surgery and continued after surgery. Sepsis of unknown origin occurred 17 days after surgery and developed into septic shock. C. butyricum was detected in blood cultures at postoperative day 26 and 45. After stopping the probiotic agent, C. butyricum was undetectable in the blood cultures. The patient died due to an uncontrollable sepsis 66 days after surgery.Case presentation 2A 63-year-old man with diabetes mellitus whose past history included total colectomy, papillectomy, and Frey’s operation at the age of 19, 34 and 48, respectively, was referred to our hospital to be treated for perihilar cholangiocarcinoma. Extended left hepatectomy with caudate lobectomy, extrahepatic bile duct resection and reconstruction of bile duct were performed. Probiotics were administered during the perioperative period. Combined probiotics that included lactomin, amylolytic bacillus and C. butyricum, were given before surgery. C. butyricum MIYAIRI 588 was given after surgery. Sepsis occurred 16 days after surgery and developed to respiratory failure 8 days later. Blood culture at postoperative day 25 revealed Enterococcus faecalis and C. butyricum. After the probiotics were stopped at postoperative day 27, C. butyricum was not detected in the blood culture. The general condition improved with intensive care. The patient was transferred to another hospital for rehabilitation at postoperative day 156.ConclusionIt should be noted that the administration of probiotics in severe postoperative complications can lead to probiotic-related bacteremia.

【 授权许可】

CC BY