Retrospective analysis of probiotic effectiveness in acute myeloid leukemia and transplant patients receiving chemotherapy

Introduction: Patients receiving intensive chemotherapy regimens are at high risk for infectious complications due to prolonged neutropenia and hospital stay. Currently, some attempt to prevent infection by utilizing probiotics in addition to prophylactic antibiotics despite a lack of data supporting this practice.

Objectives: The primary objective of the study is to compare the incidence of febrile neutropenia in those receiving and those not receiving probiotics.  Secondary objectives include a comparison of the incidence of Clostridium difficile infection, time to first fever, time to Clostridium difficile infection, incidence of documented infection, and 30 day readmission for and infectious issue.

Study Design: Retrospective chart review

Methods: Patients receiving induction or re-induction chemotherapy for acute myeloid leukemia and those undergoing hematopoietic stem cell transplants were included.  Patients were split into two groups based on receipt of probiotics.

Results: A total of 175 patients were included in the study.  There were no statistically significant differences between patients taking probiotics (n=29) and patients not taking probiotics (n=146) in regards to incidence of febrile neutropenia (79% vs. 71%, respectively, p=0.337), incidence of Clostridium difficile infection (10% vs. 6%, respectively, p=0.422), time to first fever (10 days vs. 9 days, respectively p=0.606), or 30 day readmission (28% vs. 44% respectively p=0.104). However, there was an association between probiotic use and documented infection (48% vs. 29%, respectively, p=0.04). Bacteremia (45% vs. 21%, respectively, p=0.006) was most notably increased in patients taking probiotics.

Conclusions: Our results suggest that probiotics lack benefit in preventing infections in those at risk for prolonged neutropenia and should not be recommended for use in patients without other indications for probiotic use.