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Moreover, these are live organisms and they should be used cautiously, if at all, in individuals with significant immune suppression because of the possible risk of bacteremia or fungemia. There are also numerous case reports of invasive lactobacillus infections in non-immunosuppressed (mostly elderly) patients (115,116,117).
Finally, the use of probiotics is not regulated by the Food and Drug Administration, there is no good quality control for most probiotics, and studies have shown that some probiotics contain no live organisms, or alternatively, contain organisms not on the product label (118,119). In view of the lack of efficacy data, abundant data on potential harm, high costs, and lack of biological plausibility for these non-human micro-organisms to confer colonization resistance, their use cannot be recommended.