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- Title
Restrictive Versus Permissive Use of Broad-spectrum Antibiotics in Patients Receiving Allogeneic Stem Cell Transplantation and With Early Fever Due to Cytokine Release Syndrome: Evidence for Beneficial Microbiota Protection Without Increase in Infectious Complications
- Authors
Weber, Daniela; Hiergeist, Andreas; Weber, Markus; Ghimire, Sakhila; Salzberger, Bernd; Wolff, Daniel; Poeck, Hendrik; Gessner, André; Edinger, Matthias; Herr, Wolfgang; Meedt, Elisabeth; Holler, Ernst
- Abstract
Background Intestinal microbiome contributes to the pathophysiology of acute gastrointestinal (GI) graft-versus-host disease (GvHD) and loss of microbiome diversity influences the outcome of patients after allogeneic stem cell transplantation (SCT). Systemic broad-spectrum antibiotics have been identified as a major cause of early intestinal dysbiosis. Methods In 2017, our transplant unit at the university hospital in Regensburg changed the antibiotic strategy from a permissive way with initiation of antibiotics in all patients with neutropenic fever independent of the underlying cause and risk to a restrictive use in cases with high likelihood of cytokine release syndrome (eg, after anti-thymocyte globulin [ATG] therapy). We analyzed clinical data and microbiome parameters obtained 7 days after allogeneic SCT from 188 patients with ATG therapy transplanted in 2015/2016 (permissive cohort, n = 101) and 2918/2019 (restrictive cohort, n = 87). Results Restrictive antibiotic treatment postponed the beginning of antibiotic administration from 1.4 ± 7.6 days prior to 1.7 ± 5.5 days after SCT (P =.01) and significantly reduced the duration of antibiotic administration by 5.8 days (P <.001) without increase in infectious complications. Furthermore, we observed beneficial effects of the restrictive strategy compared with the permissive way on microbiome diversity (urinary 3-indoxylsulfate, P =.01; Shannon and Simpson indices, P <.001) and species abundance 7 days post-transplant as well as a positive trend toward a reduced incidence of severe GI GvHD (P =.1). Conclusions Our data indicate that microbiota protection can be achieved by a more careful selection of neutropenic patients qualifying for antibiotic treatment during allogeneic SCT without increased risk of infectious complications.
- Subjects
GERMANY; PREVENTION of drug side effects; INFECTION prevention; CELL transplantation; HOMOGRAFTS; FEVER; ACADEMIC medical centers; FEBRILE neutropenia; GUT microbiome; HOSPITAL health promotion programs; CYTOKINE release syndrome; INFECTION; INTESTINAL diseases; RESEARCH funding; HEMATOPOIETIC stem cell transplantation; ANTIBIOTICS; DISEASE complications
- Publication
Clinical Infectious Diseases, 2023, Vol 77, Issue 10, p1432
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciad389