Empiric antibiotic use in allogeneic hematopoietic cell transplantation: should we avoid anaerobe coverage?

Detrimental Effect of Broad-spectrum Antibiotics on Intestinal Microbiome Diversity in Patients After Allogeneic Stem Cell Transplantation: Lack of Commensal Sparing Antibiotics

“…Even in the non-ASCT setting, it has been shown that antibiotic administration in general reduces gut microbiome diversity: Iizumi et al reviewed many reports indicating associations between classes, dosages, and periods of exposure of antibiotics, alterations of the gut microbiome composition, and the occurrence of autoimmune diseases like obesity and allergic asthma in children [30]. The increasing understanding of the interactions between antibiotics, bacterial dysbiosis, the pathogenesis of acute GI GvHD, and poor outcomes post-transplant has contributed to providers reconsidering antibiotic standards in the ASCT setting [31]. Since van Bekkum et al [32] and Beelen et al [33] demonstrated in mice and in clinical studies that intestinal bacteria play an important role for the development and severity of GI GvHD, strategies of total or selective gut decontamination became the clinical standards for years.…”

Epidemiologic and Clinical Characteristics of Clostridioides difficile Infections in Hospitalized and Outpatient Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients

“…Per departmental protocol, oral vancomycin, rather than metronidazole, is used as the first-line treatment of CDI in HSCT recipients in an effort to preserve the anaerobic microbial flora that play a major role in the prevention of colonization with pathogenic bacteria in this population. 24 It is important to note that fidaxomicin was used to treat 19 patients with CDI as participants in a therapeutic research study that was ongoing at our institution during our study period. 25 Findings here were consistent with those reported by others 9 using metronidazole as first-line therapy.…”

The microbiome in pediatric oncology

“…38 Accordingly, many centers are moving toward avoidance of the empiric use of antibiotics for the broad-spectrum control of anaerobic organisms within the setting of HCT, although more studies are needed. 49 In addition to the evidence that the microbiome is involved in GVHD-related and HCTrelated morbidity, emerging data have suggested that the microbiome is important in preventing disease recurrence. Peled et al examined stool samples from 541 recipients of allogeneic HCT via 16S sequencing and found that those subjects with a higher abundance of Eubacterium limosum had a decreased risk of disease recurrence or progression in both a discovery and validation set.…”

“…Broad‐spectrum antibiotic use during allogeneic HCT has been associated with increased GVHD‐related mortality, most likely due to the impact on commensal organisms 38 . Accordingly, many centers are moving toward avoidance of the empiric use of antibiotics for the broad‐spectrum control of anaerobic organisms within the setting of HCT, although more studies are needed 49 . In addition to the evidence that the microbiome is involved in GVHD‐related and HCT‐related morbidity, emerging data have suggested that the microbiome is important in preventing disease recurrence.…”