A rare case of Bacillus clausii Bacteremia after an Inadvertent Intravenous Administration of Enterogermina® in an End-stage Renal Disease Patient Awaiting Renal Transplantation

Abstract Bacillus clausii is a spore-forming Gram-positive rod used as a probiotic to treat acute diarrhea. We report a case of B . clausii bacteremia due to inadvertent intravenous (IV) injection in a patient who had end-stage renal disease and was on maintenance hemodiafiltration. B . clausii was identified in the bloodstream of this patient through blood cultures. Blood cultures persistently yielded B. clausii for 52 days despite multimodal antimicrobial therapy guided by in vitro susceptibility profiles. Eradication was ultimately achieved following intravenous dalbavancin administration, attributable to its extended elimination half-life exceeding 42 days. B. clausii is a known cause of prolonged bacteremia after oral ingestion for diarrheal illness in immunocompromised as well as immunocompetent hosts. However, inadvertent IV administration with an indwelling vascular device poses life-threating situation in our patient. We urge all clinicians for cautious use of B. clausii suspension in their healthcare facility.