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

URN zum Zitieren dieses Dokuments:

urn:nbn:de:bvb:355-epub-550462 Copy

DOI zum Zitieren dieses Dokuments:

10.5283/epub.55046 Copy

Weber, Daniela ; Hiergeist, Andreas ; Weber, Markus ; Ghimire, Sakhila ; Salzberger, Bernd ; Wolff, Daniel ; Poeck, Hendrik ; Gessner, André ; Edinger, Matthias ; Herr, Wolfgang ; Meedt, Elisabeth ; Holler, Ernst

Veröffentlichungsdatum dieses Volltextes: 20 Nov 2023 12:11

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Alternative Links zum Volltext:DOIVerlag

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Details

Dokumentenart:	Artikel
Open Access Art:	Hybrid Open Acces
Titel eines Journals oder einer Zeitschrift:	Clinical Infectious Diseases
Verlag:	Oxford University Press (OUP)
Band:	77
Nummer des Zeitschriftenheftes oder des Kapitels:	10
Seitenbereich:	S. 1432-1439
Datum:	30 Juni 2023
Institutionen:	Medizin > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie)
Projekte:	JoséCarreras Leukemia Foundation (DJCLS 01 GvHD/2016), Deutsche Forschungsgemeinschaft (DFG [German Research Foundation]; project ID 324392634; TRR [Transregio] 221; DFG via SFB [Sonderforschungsbereich]/TRR 221: project B13), Else Kröner-Fresenius Stiftung
Identifikationsnummer:	Wert Typ 10.1093/cid/ciad389 DOI
Stichwörter / Keywords:	allogeneic stem cell transplantation, intestinal microbiome, broad-spectrum antibiotics, outcome
Dewey-Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
Status:	Veröffentlicht
Begutachtet:	Ja, diese Version wurde begutachtet
An der Universität Regensburg entstanden:	Ja
Dokumenten-ID:	55046

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Zusammenfassung

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 ...

Zusammenfassung

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.

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