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Serious safety concerns are rare but include: Systemic infections : Immunocompromised individuals, those with central venous catheters, or patients with damaged gut barriers face increased risk of bacteremia or fungemia from probiotic organisms [19] [20] Antibiotic resistance transfer : Some probiotic strains may carry antibiotic resistance genes Metabolic complications : Rare cases of D-lactic acidosis have been reported with high-dose probiotic use [25] Specific populations requiring caution include patients with severe acute pancreatitis (based on the PROPATRIA trial showing increased mortality), short bowel syndrome, immunosuppression (HIV/AIDS, chemotherapy, organ transplant recipients), and critically ill individuals

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