Early <i>Clostridioides difficile</i> infection characterizations, risks, and outcomes in allogeneic hematopoietic stem cell and solid organ transplant recipients

Obeid, Karam M.; Sapkota, Smarika; Cao, Qing; Richmond, Steven; Watson, Allison P.; Karadağ, Fatma Keklik; Young, Jo Anne H.; Pruett, Timothy L.; Weisdorf, Daniel J.; Üstün, Celalettin

doi:10.1111/tid.13720

Cited by 9 publications

(7 citation statements)

References 45 publications

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“…Moreover, long prescription of a combination of broad-spectrum antibiotics is also controversial. This results in an increase in the rate of adverse effects, Clostridioides difficile and fungal infections, higher costs, longer length of hospital stay and emergence of MDR-GNB [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Since prolonged antibiotic therapy is not an evidence-based clinical practice, shortening antibiotic therapy courses is an important antibiotic stewardship strategy [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Short Course of Antibiotic Therapy for Gram-Negative Bacilli Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation: Less Is Possible

et al. 2023

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Data about short courses of antibiotic therapy for Gram-negative bacilli (GNB) bacteremia in immunosuppressed patients are limited. This is a prospective observational study performed on adult patients with cancer and hematopoietic stem cell transplant (HSCT) who developed GNB bacteremia and received appropriate empirical antibiotic therapy (EAT), had a clinical response within 7 days and survived 48 h after the end of therapy. They received antibiotic therapy in the range of 7–15 days and were divided into short course, with a median of 7 days (SC), or long course, with a median of 14 days (LC). Seventy-four patients were included (SC: 36 and LC: 38). No differences were observed in baseline characteristics or in the presence of neutropenia: 58.3% vs. 60.5% (p = 0.84). Clinical presentation and microbiological characteristics were similar in SC and LC, respectively: clinical source of bacteremia 72.2% vs. 76.3% (p = 0.68); shock 2.8% vs. 10.5% (p = 0.35) and multidrug-resistant GNB 27.8% vs. 21.1% (p = 0.50). Overall, mortality was 2.8% vs. 7.9% (p = 0.61), and bacteremia relapse was 2.8% vs. 0 (p = 0.30). The length of hospitalization since bacteremia was 7 days (interquartile range (IQR), 6–15) for SC and 12 days (IQR, 7–19) (p = 0.021) for LC. In the case of patients with cancer or HSCT and GNB bacteremia who receive appropriate EAT with clinical response, 7 days of antibiotic therapy might be adequate.

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Section: Introductionmentioning

confidence: 99%

Short Course of Antibiotic Therapy for Gram-Negative Bacilli Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation: Less Is Possible

et al. 2023

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“…Another important infection, CDI, is a common complication post-HCT (ranging from 4-27%) and has been associated with the development of acute GVHD in allogeneic HCT patients and increased mortality [78,79]. Prior antibiotic exposure remains a risk factor for the development of CDI in these patients in the early posttransplant period [80,81].…”

Section: Harm Of Unnecessary Antimicrobials In Hematopoietic Cell Tra...mentioning

confidence: 99%

Noninfectious causes of fever in hematologic malignancies. Are antibiotics still indicated?

Shahid

Epstein

2023

Current Opinion in Infectious Diseases

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Purpose of review Fever is a common manifestation of both infectious and noninfectious processes in recipients of hematopoietic cell transplantation (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy. Understanding the diverse causes of fever in these settings allows for accurate diagnosis and optimal use of antibiotics. Recent findings Herein we review common noninfectious syndromes seen in HCT and CAR-T recipients and discuss best practices in the management of these complex clinical scenarios regarding diagnosis and antibiotic use. In recent years, adverse effects of antimicrobials have highlighted the importance of antimicrobial stewardship in HCT and CAR-T patients, and an antibiotic de-escalation strategy is a safe and important tool in mitigating these adverse events, even in patients with ongoing neutropenia who become afebrile without a known infection. Common adverse events associated with antibiotics include an increased risk of Clostridiodes difficile infection (CDI), a higher incidence of multidrug-resistant organisms (MDROs), and microbiome dysbiosis. Summary Clinicians should be aware of noninfectious causes of fever in these immunocompromised patients and utilize best antibiotic practices while managing these patients.

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“…To identify the incidence, risk factors, and outcomes of CDI between the start of conditioning and 100 days after HCT, Rosignoli et al 26 conducted a retrospective study that included 261 allogeneic and 220 auto-HCT recipients. In the multivariate analysis, factors that were significantly associated with a higher risk of CDI development were In a retrospective study on 466 allo-HCT and 1,454 solid organ transplant recipients, 2 patients with CDI had a longer length of stay (LOS) from transplant admission. For allo-HCT, the median LOS in days was 35 (range 19-141) for patients with CDI versus 29 (range for patients without CDI.…”

Section: Adultsmentioning

confidence: 99%

“…Clostridioides difficile infection (CDI) is the most common healthcare‐associated infection in Europe and North America, posing a substantial clinical burden in patients with hematologic diseases who are frequently hospitalized, immunosuppressed, and highly exposed to antibiotics 1,2 . CDI is responsible for up to 10%–25% of antibiotic‐associated diarrhea and 50%–75% of antibiotic‐associated colitis 3 .…”

Section: Introductionmentioning

confidence: 99%

Clostridioides difficile infection in the allogeneic hematopoietic cell transplant recipient

Lo Porto,

Mularoni,

Castagnola

et al. 2023

Transplant Infectious Dis

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Clostridioides difficile (CD) is one of the most important causes of diarrhea in hospitalized patients, in particular those who undergo an allogeneic hematopoietic cell transplant (allo‐HCT) and who are more at risk of developing a CD infection (CDI) due to frequent hospitalizations, iatrogenic immunosuppression, and prolonged antibiotic cycles. CDI may represent a severe condition in allo‐HCT patients, increasing the length of hospitalization, influencing the intestinal microbiome with a bidirectional association with graft‐versus‐host disease, and leading to unfavorable outcomes, including death. The diagnosis of CDI requires the exclusion of other probable causes of diarrhea in HCT patients and is based on highly sensitive and highly specific tests to distinguish colonization from infection. In adult patients, fidaxomicin is recommended as first‐line, with oral vancomycin as an alternative agent. Bezlotoxumab may be used to reduce the risk of recurrence. In pediatric patients, vancomycin and metronidazole are still suggested as first‐line therapy, but fidaxomicin will probably become standard in pediatrics in the near future. Because of insufficient safety data, fecal microbiota transplantation is not routinely recommended in HCT in spite of promising results for the management of recurrences in other populations. image

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Early Clostridioides difficile infection characterizations, risks, and outcomes in allogeneic hematopoietic stem cell and solid organ transplant recipients

Cited by 9 publications

References 45 publications

Short Course of Antibiotic Therapy for Gram-Negative Bacilli Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation: Less Is Possible

Short Course of Antibiotic Therapy for Gram-Negative Bacilli Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation: Less Is Possible

Noninfectious causes of fever in hematologic malignancies. Are antibiotics still indicated?

Clostridioides difficile infection in the allogeneic hematopoietic cell transplant recipient

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