M I C H A E L C H I K I N D A S

“To … hell… with… yogurt.”
Chas Addams - The Half-Baked Cookbook. Simon and Schuster, New York, NY 2005

The Bulgarian farmer's  longevity and healthy life  are the result of the  consumption of fermented  dairy products. E. Metchnikoff

Probiotics ‐ definitions
Published Definition Substances produced by microorganisms which promote the growth of other microorganisms Organisms and substances which contribute to intestinal microbial balance A live microbial feed supplement which beneficially affects the host animal by improving its intestinal microbial balance A viable mono- or mixed-culture of microorganisms which applied to animal or man, beneficially affects the host by improving the properties of the indigenous microcflora Living microorganisms, which upon ingestion in certain numbers, exert health benefits beyond inherent basic nutrition Reference Lilly and Stillwell 1965 Parker 1974 Fuller 1989 Havenaar and Huis In’t Veld 1992 Schaafsma 1996 Naidu et al. 1999

A microbial dietary adjuvant that beneficially affects the host physiology by modulating mucosal and systemic immunity, as well as improving nutritional and microbial balance in the intestinal tract

Live microorganisms which when administered in adequate amounts confer a health benefit on the host.

A preparation of or a product containing viable, defined microorganisms in sufficient numbers, which alter the microflora (by implantation or colonization) in a compartment of the host and by that exert beneficial health effects in this host Live microorganisms which when administered in adequate amounts confer a health benefit on the host.

Schrezenmeir and de Vrese 2001 FAO/WHO report, October 2001

1

“Global Probiotic Market to Grow – Analyst.7% to  $5bn – 5% growth until 2013 • Growth factors include: – Consumer understanding of the effect of nutrition on  health – Rising healthcare costs Source: Tallon 2009.” FLEXNEWS. US probiotic market grew by 8.Probiotic Market • Global market is currently valued at $22. US Probiotic Products • Dairy dominate the market • Beverages and snacks grow in size Probiotic products launched in United States. Europe and  USA • Between 2003 and 2005. such as: • • • • • • Gastro‐intestinal probiotics G i i l bi i Skin probiotics Scalp probiotics Probiotics of the oral cavity Probiotics of the underarm and feet Urogenital (including vaginal) probiotics 2 . by category (2000‐2010)  18 16 Num of Products ber s 14 12 10 8 6 4 2 0 2000 2003 2004 2005 2006 2007 2008 2009 2010 Year Dairy Non-Alcoholic Beverages Snacks Other Source: Mintel GNPD 22 Jan 2011 Human probiotics Human probiotics can be grouped according to the  ecological niches of the human body they occupy (or  the part of the body they deliver their health‐ promoting action to). 27 Sept 2010.8 billion in 2015 • Target consumers are mainly located in Japan.6 billion and  projected to reach $28. 27 Sept 2010. Web.

paracasei Lb. Nestlé Switzerland Urex. reuteri Bifidobacterium species • • • • • • • Bf. Prevention and treatment of acute diarrhea bifidum Sc. casei Bf. acidophilus. Bf lactis Bf. Lb casei Shi t Lb rhamnosus HN001 Lb i Shirota. lactis BB-12. USA Origin Yakult. Food Research International 35 (2002). Lb. Sweden Arla Foods. delbrueckii ssp.. Lactobacillus RC-14 Eradication of vaginitis through restoration of dominated vaginal flora Lower risk of urinary tract infections through restoration of dominated vaginal flora Probiotic lactic acid bacteria marketed worldwide Strains Lactobacillus casei Shirota Lactobacillus crispatus CTV05 Lactobacillus reuteri MM53 Lactobacillus casei F19 Bifidobacterium lactis HN019 Lactobacillus rhamnosus GG Propionibacterium freudenreichii ssp. animalis Bf. crispatus Lb. pp. Bf. johnsonii La1. fermentum Lb. Lactobacillus B-54. shermanii JS Lactobacillus acidophilus NCFM Lactobacillus acidophilus NCFB 1748 Lactobacillus johnsonii LA1 (NCC 533) Lactobacillus acidophilus LA10 (NCC 90) Lactobacillus fermentum RC-14 Lactobacillus rhamnosus GR-1 Lactobacillus casei DN-114 001 Bifidobacterium animalis DN-173 010 Lactobacillus plantarum 299v Lactobacillus rhamnosus 271 Lactobacillus casei CRL 431 Bifidobacterium lactis BB-12 Lactobacillus acidophilus LA-5 Lactobacillus bulgaricus LBY27 Streptococcus thermophilus STY-31 Rhodia. Introduction to pre.Probiotics Species Lactobacillus species • • • • • • • • • • • • • • • Lb. helveticus Lb. Bf. Lb. Canada Danone. bifidum Bf. casei ssp. lactis Leuconostoc mesenteroides ssp. Lb. brevis Lb. adolescentis Bf. Lb. thermophilus Cited by W. acidophilus LB Lb. USA BioGaia. casei Lb. lactis BB-12 Inhibition of the pathogen growth and decrease urease enzyme activity necessary for the pathogen to remain in the acidic environment of the stomach Remediation in inflammatory conditions through modulation of the gastrointestinal microflora Prevention or delay of the onset of certain cancers Enhancement of immune parameters Prevention of allergic diseases onset Helicobacter pylori infection and complications Inflammatory diseases and bowel syndromes Cancer in gastrointestinal tract Mucosal immunity Allergic symptoms Cardiovascular disease Lactobacillus sp. johnsonii Lb. Propionibacterium sp. rhamnosus LC-705. rhamnosus Lb. Schillinger. USA Nestlé. rhamnosus GG. bulgaricus Lb. Finland Adapted from FAO/WHO 2001 3 . dextranicum Pediococcus acidilactici Propionibacterium freudenreichii Saccharomyces boulardii Streptococcus salivarius ssp. h HN001. Bf. Prevention and therapy of ischemic heart syndromes Bacterial and yeast vaginitis Urinary tract infections Lb. gasseri Lb. Lb. casei Shirota. rhamnosus GG. Hansen. amylovorus Lb. France Valio. Lb. Bifidobacterium sp. 109–16 Examples of probiotic strains used in prevention and treatment of some diseases Disorders Diarrhea caused by pathogenic bacteria and viruses Strains Clinical outcomes Lb. rhamnosus GG Lactobacillus GR-1. France Probi AB. rhamnosus GG. Sweden Chr. acidophilus LA-2. Lb.H. Lb. breve Bf. infantis Bf.and probiotics. acidophilus HN017. acidophilus Lb. Japan Gynelogix. lactis Lb. rhamnosus GG Lb. Lactis HN019 Lb. Lb. cremoris Lactococcus lactis ssp. Lb. Holzapfel and U. Denmark/Sweden Danisco. longum Other species Bacillus cereus Clostridium botyricum Enterococcus faecalis Enterococcus faecium Escherichia coli Lactococcus lactis ssp ssp. plantarum Lb. thermophilus caused by rotaviruses in children Lb. salivarius.

  g p condiments • Dietary supplements – Infant formula. Lactobacillus paracasei 8700:2 (Probi) 4bn per p 1L ProViva Female Danone Juice Drink Lactobacillus plantarum 299v (Probi) Not provided Gefilus Valio Juice Lactobacillus rhamnosus GG (Valio) 50 bn per 1L Naked Probiotic PepsiCo Juice Bifidobacterium lactis HN019 5 bn per 300ml 4 . kefir. powders • Clinical therapeutics and health supporting/promoting  formulations Non‐Dairy Beverages Product Company Type Strain Lactobacillus plantarum 299v. cheese  • Non‐dairy foods – Beverages. chocolate. cereal. ice cream. bars. capsules. drops.Human probiotics Human probiotics can be grouped according to Gastro‐intestinal probiotics the ecological niches of the human body they occupy (or the part of the body they deliver their health-promoting action to). pizza. such as: • • • • • • Gastro‐intestinal probiotics G i i l bi i Skin probiotics Scalp probiotics Probiotics of the oral cavity Probiotics of the underarm and feet Urogenital (including vaginal) probiotics Probiotic Products • Dairy foods – Beverages. tablets. yogurt. Bifidobacterium lactis Bi-07 (Probi) Dose 20 bn per 300ml* Claim Clinically proven to promote healthy digestion and support natural immunity Helps the body’s p y natural defenses Helps body to increase iron uptake by about 50% Enhances natural defenses Help promote healthy digestive and immune system GoodBelly NextFoods Juice Drink Bravo Friscus Skanemejerier % 100% Juice Lactobacillus plantarum HEAL9.

com/newspage/030403a.  CLAIM: “GoodBelly is specifically designed to be enjoyed daily in order to  boost your immune system and improve digestive health by replenishing  your body’s healthy microflora.  founded by Steve Demos (who also founded Silk soy milk).com http://goodbelly.Swedes first with non‐dairy probiotic "little bottle” www. Kagome aimed to generate 10 billion yen ($86 mil)  from sales of the new beverage in the first year.new-nutrition. containing Lactobacillus plantarum 299v (Probi).  5 . on March 14. will be open‐priced. The 100ml  ($1 45) for three 80ml packs The 100ml bottle. 2006 The new product.  Twenty billion live bacteria are in each serving juices to provide digestive  health. It comes in three  sizes: 130ml. GoodBelly is an  organic fruit juice‐based probiotic beverage that contains a patented  probiotic called Lactobacillus plantarum 299v. Three flavors include: Brilliant Blueberry. GoodBelly’s patented Lp299v probiotic  strain has been clinically proven in over 15 years of research. •2003 marked approval of its health claims— the first given to a probiotic product marketed in Europe — enabled Skane to market ProViva on its ability to calm an unsettled stomach by reducing the formation of gas. and has tested well for its effects on Irritable Bowel Syndrome. http://www. Labre. Prices are 105  yen (90 cents) for a 130ml bottle and 170 yen  ($1.  helps maintain health. which was developed in the  U. The brand is an extension of Skånemejerier’s highly successful Pro Viva probiotic juice which in 2001 sold some 15 million liters in Sweden – a country of just 8 million people. which will be available via home  delivery only. which contains  Lactobacillus brevis subsp.com/ The first probiotic juice was launched in the fall of 2007 by Next Foods.htm • Skane’s ProViva probiotic fruit arrived in the Swedish marketplace in 1994.45) for three 80ml packs. •Pro Viva Shot! is an 80 ml juice drink which delivers 250 million bacteria (more than Proviva).” Tokyo (JCN) ‐ Japanese food conglomerate Kagome  announced their launch of a lactic acid bacteria  beverage series. 100ml and 80ml.functionalingredientsmag. Peach Mango and  Strawberry Rosehip.K. coagulans (Labre).

 2009 Dannon settles class action suit over Activia health claims Dannon has reached a settlement in a class action lawsuit filed  over misleading advertising on its Activia and DanActive lines of  yogurt.  As part of the settlement.  Do I really want “it” to go faster?! = September 23. according to the Associated Press.businessweek. http://www.  The health claims indicated that the yogurt's bacteria would help  with digestion or with the immune system. company does  As part of the settlement the White Plains N Y company does not admit any wrongdoing but will create a $35 million fund to  reimburse qualified consumers up to $100 for products  purchased.Activia® is a great‐tasting lowfat  yogurt from Dannon® that  contains Bifidus Regularis™ a  natural probiotic culture that  can help regulate your digestive  system by helping reduce long  intestinal transit time.csgrr. N.Y.com 6 . the White Plains.com/Dannon/  http://bx.

 a common procedure at the time.  autoimmune reaction to the bacteria that causes  strep throat – Streptococcus pyogenes. advanced probiotic discovered  by Professor John Tagg from the Department of  Microbiology and Immunology at the University of  Otago in New Zealand.  It has been shown to safely control the bacteria  that frequently causes strep throat.com/content/dg56pk5k48l6w5h1/fulltext. it is  important to prevent a recurrence of strep. http://www. http://culturedcare.  upper respiratory infections. inflammatory condition that makes joints  swell and redden.com/ 7 .Human probiotics Human probiotics can be grouped according to the  ecological niches of the human body they occupy (or  the part of the body they deliver their health‐ promoting action to). more than 35 years later.springerlink. John Tagg contracted  an especially bad case of strep throat that led to  rheumatic fever. BLIS K12 is the special  BLIS probiotic strain derived from the friendly  bacteria S. John s doctor put him on a course of  important to prevent a recurrence of strep John’s doctor put him on a course of antibiotics every day for 10 years.html http://culturedcare. a revolutionary ORAL probiotic that prevents  infection (including strep throat) where it begins – in your mouth. Rheumatic fever is a delayed. Today. such as: Probiotics of the oral cavity Gastro‐intestinal probiotics G i i l bi i Skin probiotics Scalp probiotics Probiotics of the oral cavity Probiotics of the underarm and feet Urogenital (including vaginal) probiotics • • • • • • K12 story When he was just a boy of 12. This childhood experience inspired Professor Tagg to devote his life to the study of  friendly probiotic bacteria that can prevent strep throat and other infections that enter  through your mouth. earache. salivarius BLIS K12. Professor Tagg is a world renowned microbiologist from  the University of Otago in New Zealand whose targeted research has led to the  discovery of S. Because rheumatic fever can  permanently weaken and damage the heart. salivarius. It is a very  painful. sinus infections and  halitosis (bad breath).  BLIS stands for Bacteriocin‐Like‐Inhibitory‐ Substance and is the naturally occurring  component of certain strains of micro‐organisms  component of certain strains of micro‐organisms (probiotics) which control undesirable and  disease‐causing bacteria.com/ K12 story BLIS K12 is a new.

 such as: • • • • • • Gastro‐intestinal probiotics G i i l bi i Skin probiotics Urogenital probiotics Scalp probiotics Probiotics of the oral cavity Probiotics of the underarm and feet Urogenital (including vaginal) probiotics Bacterial vaginosis • Lactobacillus is replaced by several pathogenic bacteria of which Gardnerella vaginalis is most prevalent1. Human probiotics Human probiotics can be grouped according to the  ecological niches of the human body they occupy (or  the part of the body they deliver their health‐ promoting action to). Transm. et al. premature rupture of membranes and low birth weight2. • Associated with premature labor. Infect. 1993. Int J Antimicrob Agents. 2006. Periodontol. Clin. higher risk of acquisition of HIV3 and herpes simplex virus type 2 infection4. 180:6:1863-1868. 1999. Gynecol. 1993. 2003 Sex. 48:11:885-892. 1999. 30:5:405-410. 1 Hill. J. 28.cz Nisin: Howell et al. Histatin-5: Paquette et al. 20(5):335-9. 4 Cherpes 5 Uehara et al. 1997. S30-S34. 169:2. 2 Flynn 3 Martin et al. et al. Periodontol. Clin.www.Prac. 8 . J. • Cured by antibiotics: clindamycin or metronidazole. J.2:450-454. Dis.24(4):216-22. J. Obstet.Fam. but there is high risk of reoccurrence5. Dis.stenata.1.

Vagiforte Vagiforte capsules and tablets contain a mixture of lyophilized lactic acid bacteria. Administration of high doses of these bacteria helps to prevent the development of vaginal thrush caused by Candida albicans.za 9 . namely Lactobacillus acidophilus.Problems associated with  the treatment of BV Credit: Stem Jems / Photo Researchers. which are natural inhabitants of the human vagina and intestinal tract tract. Bifidobacterium bifidum and Bifidobacterium longum.co. Lactic acid bacteria control the overgrowth of pathogenic microorganisms in the human digestive tract and prevent their transfer to the uro-genital tract. Inc. www.bioflora. frequently associated with broad-spectum antibiotic treatment.

Vaginal lactobacilli Lactobacilli protect the vagina  from overgrowth of pathogens  by producing: •lactic acids (0. 2001.7 – 2 5 m /ml) lactic acids (0 7 2. bacteriocins. 375-9 10 ..  start producing antimicrobials such as hydrogen  peroxide.Alternatives? Can we consider the “strain replacement  therapy” approach as an alternative to use  of highly‐concentrated and target‐ deliverable specific antimicrobials? Bottleneck of the strain  replacement therapy In order to succeed in a strain replacement therapy  approach. if it will survive all the previous phases.5 mg/ml) •hydrogen peroxide (82% of natural isolates) •bateriocins (73% of natural isolates) 63% of natural isolates produce all three defense factors Aroutcheva et al. Am J Obstet Gynecol. 185(2). lactic acid etc. the probiotic has to: • Migrate to the surface of the epithelial cells • Adh Adhere onto the epithelial cells t th ith li l ll • Successfully colonize the epithelial cells and  develop a functional biofilm • Finally.

Think twice BEFORE you put it into your mouth Potential Subtilosin Applications • Subtilosin has strong antimicrobial activity against  Gardnerella vaginalis. the organism responsible for  bacterial vaginosis (BV) bacterial vaginosis (BV) – BV is typically treated with conventional antibiotics • Up to 30% of cases return with developed antibiotic resistance – Antibiotic‐resistant BV infections can dramatically increase the  likelihood of contracting HIV and progression of the virus 11 .

com/wp-content/uploads/2009/03/chocolatecrisp_large. pentocin ‐ Lactic acid.blogspot.barsarefood.cookerati.com http://www.nonchalantmom. saponin.WHAT? ‐ Helps to restore and maintain healthy status ‐ Eliminates abnormal discharge ‐ Eliminates odor ‐ Prevents itching and burning sensation ‐ Contraceptive ‐ Antiviral  WHY? ‐ All substances combined ‐ Subtilosin ‐ Subtilosin ‐ Subtilosin.com www.jp 12 . subtilosin ‐ Zn lactate www. poly‐lysine.

 coagulans since this strain possesses key features  that are identical to the aforementioned spore‐former. manufacturing and  handling attributes. sporogenes have proven  successful in the treatment of  gastrointestinal disorders. non‐alcoholic beverages and even instant  tea and coffee. who reviewed safety and  toxicology data. hepatic  encephalopathy and in growth  improvement of farm animals.M. snacks.Lactospore®: a Probiotic of Choice L. Nowotelnow. candy. GRAS approval will now allow food manufacturers to add  Lactospore® to a variety of foods and beverages ranging from baked goods to  milk products. mutans Lactospore®: a Probiotic of Choice B. assembled by Soni & Associates. although it is not an accepted name for this species according to  the Bergey’s Manual of Determinative Bacteriology. aphthous  stomatitis. soups.  It should be mentioned that in many cases. coagulans use the name L. commercial products containing  B. non‐ specific vaginitis.  Supernatant of L. Clinical trials with  L.  reported health benefits Lactospore®’s GRAS status was determined by an independent panel of  scientists. sporogenes on the labels for marketing  purposes. sporogenes inhibits S.  13 . Horowitz‐ Wlassowa and N. sporogenes was first isolated and described in 1933 by L. the strain does not require refrigeration to maintain its  reported health benefits. Because of its convenient storage. coagulans culture produces only the beneficial L‐(+) form of lactic acid in the  gastrointestinal tract. It was later classified as B.W.

(2008b). coagulans Dosage form tablet powder Therapeutic use Lactose intolerance. (2003). the British  medical journal The Lancet published the  findings of the study into the effect of probiotics  on acute pancreatitis. Ammor et al. enhancing immune response Geriatric and convalescence therapy. Adjuvant to antibiotic therapy. B complex L. Florez et al. 2008 edition. (1992). (1996) Ammor et al.  p The most important conclusion is that in people  with severe acute pancreatitis. dyspepsia. sporogenes*. convalescence therapy. sporogenes*. (2007). B complex deficiency adjuvant with antibiotics B complex deficiency adjuvant with antibiotics adjuvant with antibiotics adjuvant with antibiotics and chemotherapeutic agents L. vitamins B. (2007). B complex tablets powder capsule powder capsule powder tablet capsule tablet http://www. oral rehydration therapy Antibiotic with adjuvant for nutritional status enhancement and maintenance of gastrointestinal ecological balance Diarrhea. Kazimierczak et al. zinc L.com/ “Utrecht clinical trial” In its February 14.com/content/v48881431j1521j8/fulltext. B complex. (1994) Cauwerts et al. and van Hoek et al. (2007). (2007). probiotics did not  reduce the number of infections but resulted in a  higher number of deaths. Aquilanti et al. B complex L. (2008a). sporogenes *. coagulans Trade Name SPORLAC LACTOSPORE SANVITA Composition L. (2008b). hyperchole. sporogenes* L. sporogenes*. enhancing immune response. (2008b) van Hoek et al. Hummel et al. sporogenes* B. ampicillin capsules LACBON BECOPLUS NUTROLIN-B GUTFLOR VIZYLAC L. Non-specific vaginitis.Some commercially available preparations of B. (2007). Gfeller et al. van Hoek et al. (2007). (2008b) Ammor et al. gastro-intestinal infections. sporogenes L sporogenes* isotonic salts powder L. uticaria. (2008a). Aquilanti et al.umcutrecht. Cauwerts et al. leucorrhea and after antifungal /antiprotozoal treatment. (2008a). (2008b) van Hoek et al. L. and Lin et al. http://www. (2006). sporogenes* vaginal tablets SANVITONE MYCONIPÒ BACTOLYTE AMPILAC L. eczema. (2006). flora modifier after chemotherapy.html 14 . Aquilanti et al. hepatic coma and precoma. (2008a) Resistance phenotype Mechanism of action Location (when studied) References erm(B)/erm(C)/erm(T) erm(LF)/erm(GT) MLS Ribosomal methylation Plasmid transposon chromosome mef(A) Cat tet(W)/tet(M)/tet(S) tet(O)/tet(Q)/tet(36) tet(Z)/tet(W/O) tet(O/W/32/O/W/O) tet(K)/tet (L) Bifidobacterium tet(W)/tet(M)/tet(O) tet(W/32/O)/tet(O/W) tet(L) erm(X) Macrolide Chloramphenicol Efflux Antibiotic acetylation – Plasmid Tetracycline Ribosomal protection Plasmid transposon chromosome Tetracycline Efflux Plasmid Tetracycline Ribosomal protection Chromosome Tetracycline MLS Efflux Ribosomal methylation Chromosome Transposon http://www. Vitamins B. (2006) Ahn et al (1992) al. sporogenes*. strophilus.lactospore. and Tannock et al. Hummel et al. (2006).springerlink.nl Examples of the main antibiotic resistance determinants  identified and characterized in lactobacilli and bifidobacteria Gene(s) Lactobacillus Ammor et al. improves digestion. granules L-lysine monochloride L.sterolemia. sporogenes*. sporogenes*. Klare et al. Klare et al. (2007) Ammor et al. minerals antioxidants fungal capsules diastase.

subtilis 8 × 109 Not stated spores/day B... (2004) 10 weeks Risk factors Diabetes mellitus Mitral regurgitation Dental extraction Prematurity Short gut syndrome Prematurity. rhamnosus 3 × 109 API 50 CH. Antibiotic diarrhea B. 2008)  Very rare among probiotics (Vesterlund et al.html Proposed in vitro safety assessments of probiotics Assessment Presence of antibiotic resistance genes Mobility of antibiotic resistance genes Adhesion to host tissues Resistance to host defense mechanisms Presence of virulence genes and toxic  metabolites Hemolysis Bile salt deconjugation Presence of macrocapsules Notes Commonly used safety assessment Commonly used assessment. Short gut syndrome..springerlink. (1998) and 73 Spinosa et al.com/content/v48881431j1521j8/fulltext.. ..yogurt could replace many  pharmaceutical drugs. Antibiotic diarrhea Land et al.org/news/healing_power.Cases of bacterial sepsis in humans temporally related to probiotic use Study Rautio et al. CVC.. subtilis 8 × 109 Neoplastic disease spores/day B. subtilis 8 × 109 Not stated spores/day Chronic lymphocytic B. (1999) Mackay et al. PFGE of DNA Liver abscess restriction fragments L. Short gut syndrome. (2005) 4 months LGG Probiotic Method of identification Form of sepsis API 50 CH. 2008b)  Rarely used safety assessment (Baumgartner  et al... Inflamed intestine. Rotavirus diarrhea Cardiac surgery. 1998)  http://www. Pyrolysis mass cfu/day Endocarditis spectrometry LGG LGG No confirmatory typing PFGE of DNA restriction fragments Bacteremia Bacteremia De Groote et al.html If the science of probiotics holds up in clinical trials.. Jejunostomy feeding. (2005) 11 months LGG ¼ capsule/day rRNA sequencing Bacteremia LGG 1010 cfu/day 47 25 Richard et al.. 2008b)  Commonly used safety assessment (Vesterlund et al. subtilis 8 × 109 Not stated spores/day B. particularly  relevant for Enterococcus Not recommended as part of safety  assessment (Vankerckhoven et al. subtilis 109 spores leukemia /day Repetitive element sequence-based PCR DNA fingerprinting Repetitive element sequence-based PCR DNA fingerprinting Antibiotic susceptibility Antibiotic susceptibility Antibiotic susceptibility Antibiotic susceptibility 16S rRNA sequencing Endocarditis Bacteremia Bacteremia Bacteremia Bacteremia Bacteremia Bacteremia http://www. 2007)  Particularly relevant for Bacillus and  Enterococcus (Tompkins et al. Gastrostomy.  2007)  Irrelevant as safety measurement  (Vankerckhoven et al. (1988) 63 79 Oggioni et al.htm 15 . (1999) Age 74 67 3 months Kunz et al.springerlink. (2000) Cerebral palsy.com/content/v48881431j1521j8/fulltext.. LGG 1010 cfu/day CVC. Prematurity. http://www.usprobiotics. Parenteral nutrition.

Sign up to vote on this title
UsefulNot useful