Fungemia Due toSaccharomycesSpecies in a Patient Treated with EnteralSaccharomyces boulardii

the Saccharomyces species was incorrect, with the usual confusion As a pharmaceutical biotherapeutic agent, Saccharomyces boulbetween S. boulardii and S. cerevisiae [1, 2, 5]. ardii has been used for years outside of the United States to treat Given that S. boulardii may be initially misidentified as S. cerediarrhea [1] and is considered to be safe. Nevertheless, serious visiae, it is likely that S. boulardii is responsible for saccharomyces side effects can occur. fungemia in patients receiving enteral Ultra-Levure. High doses A 78-year-old immunocompetent woman was admitted to the of Ultra-Levure associated with antibiotics effective against anaerintensive care unit because of an acute exacerbation of chronic obes, bowel diseases, and/or immunodeficiency seem to be risk obstructive pulmonary disease. Current treatment consisted of antifactors for such fungemia; our observation suggests that fungemia biotics (amoxicillin/clavulanic acid), mechanical ventilation, and due to Saccharomyces species can also occur in immunocompetent enteral feeding via a gastric tube. On hospital day 12, diarrhea hosts without bowel disease. Enteral S. boulardii is widely used appeared. Investigation for stool pathogens was negative; loperain the prevention or treatment of diarrhea; therefore, physicians mide and S. boulardii (Ultra-Levure, 1.5 g/day [Biocodex, Monmust be aware of the possibility of potentially serious side effects. trouge, France]) were administered via the gastric tube (day 13) The reported occurrence of such side effects is infrequent at presfor 15 days. On day 18, antibiotic therapy was changed to that with ent, and no current guidelines exist for their treatment. ceftazidime and ciprofloxacin because of a nosocomial pulmonary