Lactobacilli in necrotizing pancreatitis

Accessible online at: www.karger.com/pan isms to pancreatic necrosis. However, for lactobacilli to cause a clinically relevant infection is extremely rare as pointed out by Dr. Z’Graggen. This case is indeed remarkable since Lactobacillus was the only bacterium cultured. It remains unknown whether the Lactobacillus caused the (presumed) primary infection since no fi ne needle aspiration was performed in the initial admission. We wonder whether during (planned) surgical debridement other bacterial fl ora was either cultured or detected by means of 16s DNA from the (peri-)pancreatic necrosis. Furthermore we would like to comment that a patient with severe acute pancreatitis can hardly be called ‘immunocompetent’; it is the severe immune suppression normally seen in the second phase of acute pancreatitis that is causative for the infectious complications [4] . Sir, It is with interest that we read the case report by Dr. Z’Graggen et al. [1] regarding a patient with pancreatic infection due to Lactobacillus paracasei . The topic is of special interest since a recent placebo-controlled trial demonstrated that certain Lactobacillus strains (probiotics) can in fact reduce infections in patients with severe acute pancreatitis [2] . It is hypothesized that probiotics reduce small bowel bacterial overgrowth and subsequent bacterial translocation, thus preventing infectious complications. In the Netherlands, our study group is currently conducting a multicenter placebo-controlled trial to validate these fi ndings [3] . Lactobacillus paracasei subsp. tolerans is, to the best of our best knowledge, not being used as a probiotic organism. It is felt that lactobacilli may indeed translocate along with other commensal enteral organReferences