Weber, Daniela and Hiergeist, Andreas and Weber, Markus and Ghimire, Sakhila and Salzberger, Bernd and Wolff, Daniel and Poeck, Hendrik and Gessner, Andre and Edinger, Matthias and Herr, Wolfgang and Meedt, Elisabeth and Holler, Ernst (2023) 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. CLINICAL INFECTIOUS DISEASES, 77 (10). pp. 1432-1439. ISSN 1058-4838, 1537-6591
Full text not available from this repository. (Request a copy)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 & PLUSMN; 7.6 days prior to 1.7 & PLUSMN; 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. Intestinal microbiome diversity plays a crucial role in outcome after allogeneic stem cell transplantation. Restrictive use of systemic antibiotics, particularly in cases of cytokine release syndrome-induced fever, may help to prevent intestinal dysbiosis without increasing the risk of infectious complications.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | VERSUS-HOST-DISEASE; NEUTROPENIC PATIENTS; INTESTINAL MICROBIOME; MEDIATED MODIFICATION; GUT MICROBIOTA; DIVERSITY; RISK; PREVENTION; GUIDELINES; BACTERIAL; allogeneic stem cell transplantation; intestinal microbiome; broad-spectrum antibiotics; outcome |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie) Medicine > Lehrstuhl für Medizinische Mikrobiologie und Hygiene Medicine > Abteilung für Krankenhaushygiene und Infektiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Feb 2024 09:30 |
| Last Modified: | 22 Feb 2024 09:30 |
| URI: | https://pred.uni-regensburg.de/id/eprint/59056 |
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