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Abstract
SIR—Sipsas and colleagues [1] raise concerns about both the safety and the platelet-aggregation and adherence properties of lactobacilli that are used as probiotics [2]. In reply, we would point to the thorough search of the literature for the years 1992–2001 that was done by Avlami and colleagues [3], who identified 5 cases of endocarditis in which the patients had consumed either yogurt or probiotic preparations daily. The infective strain could not be confirmed to be identical to the ingested strains in any of the cases reported [4]. In fact, the only study that used DNA-based methods showed that the strains were not identical. The other 4 reports could not exclude nonidentity. The most compelling evidence is a report of a single case of liver abscess associated with lactobacilli in an elderly patient with diabetes [5]. Therefore, there is no conclusive evidence regarding the risks of bacteremia or endocarditis caused by probiotic lactobacilli.

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