Antibiotics Prevent Common Hospital-Acquired Infection in Transplant Patients

Clostridium difficile infection, more commonly known as C. diff, causes diarrhea and can lead to severe inflammation of the bowel and these infections can be not only extremely uncomfortable, but can lead to other severe medical complications.

Infection remains a leading cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation (alloHCT) and among the most common infectious complications in alloHCT recipients is C.difficile infection (CDI), a healthcare-associated, toxin-mediated diarrheal disease occurring in up to 30% of alloHCT recipients.

Scientists at the Hospital of the University of Pennsylvania (Philadelphia, PA, USA) and their colleagues conducted a retrospective cohort study to examine the effectiveness of CDI prophylaxis with oral vancomycin compared to no prophylaxis in 105 consecutive adults undergoing alloHCT at the University of Pennsylvania between April 2015 and July 2016. Patients received oral vancomycin 125 mg twice daily starting on the day of inpatient admission for alloHCT and continued until day of discharge. Prior to the initiation of this pilot, pharmacologic prophylaxis for CDI was not administered to the 55 in the control arm.

Testing for C. difficile in patients with diarrhea was performed using an immunoassay for glutamate dehydrogenase and toxins A and B. Indeterminate results were confirmed by a molecular assay. Control and intervention patients were characterized by potential risk factors for CDI, including demographics, prior CDI, and recent broad-spectrum antibiotic use. The study focused on patients with blood cancers undergoing an allogeneic stem cell transplant, in which patients receive stem cells from a healthy donor after high-intensity chemotherapy or radiation. Since these transplants require patients’ immune systems to be suppressed so they do not reject their new bone marrow cells, this group of patients is at high risk for life-threatening infections as their new immune systems develop.

The team found that the results were significant as 73 patients who took the drug prophylactically; none developed C. diff during their inpatient admission for the stem cell transplant, which lasted an average of 33 days. In a group of patients who did not get the drug in advance, 11 out of 55 (20%) developed the infection, which is within the national average of that ranges from 20% to 30%. While the treatment has proven effective at preventing C. diff, the study did not show a shortened length of hospitalization among the patients.

David Porter, MD, a Professor in the Leukemia Care Excellence and the senior author of the study said, “What we want to do is maximize the appropriate use of antibiotics. With our control group showing a 20% infection rate, that means we’re giving the antibiotics to a lot of people who would not have otherwise developed C. diff, but given the risks associated with the condition for these patients, our results demonstrate a potential path to protecting more of them during a very vulnerable period in their recovery.” The study was presented at 58th Annual American Society of Hematology Meeting, held December 3-6, 2016, in San Diego, CA, USA.

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Hospital of the University of Pennsylvania