Photo Credit: Meletios Verras

The following is a summary of “Interventional antibiotic treatment replacing antibiotic prophylaxis during allogeneic hematopoietic stem cell transplantation is safe and leads to a reduction of antibiotic administration,” published in the September 2024 issue of Hematology by Toenges et al.

Patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT) suffer a higher risk of infection-related death, especially before engraftment. Systemic antibiotic prophylaxis (SAP) is commonly used during neutropenia. However, it can disrupt the intestinal microbiome, raising risks of graft-versus-host disease (GVHD), clostridium difficile infection (CDI), and multi-drug resistant (MDR) bacteria.

Researchers conducted a retrospective study evaluating the safety and effectiveness of an exclusively interventional antibiotic treatment (IAT) compared to SAP in adult patients with alloHSCT.

They compared IAT and SAP, analyzing patients with alloHSCT. The study primarily compared the duration of antibiotic therapy and the incidence of Bloodstream infections (BSI). Other outcomes included ICU transfers, non-relapse mortality (NRM), overall survival (OS), and acute and chronic GVHD rates. 

The results showed that IAT involved a shorter duration of antibiotic therapy (24 vs. 18 days, P<0.001). The BSI by day + 100 post-HSCT was higher in the IAT group than SAP (40% vs. 13%, P<0.001). However, similar ICU transfer rates (13% vs. 6%, P=ns) and NRM (11% vs. 10%, P=ns)) were found in both groups. In 3 years, OS rates were 69% for SAP and 66% for IAT. The incidence of acute GVHD grade II-IV (30% vs. 39%) and chronic GVHD (50% vs. 45%) did not significantly differ. There was a tendency for more severe chronic GVHD in the SAP group (28% vs. 13%, P=0.08). The IAT group led to less use of cefotaxime, carbapenem, and glycopeptide antibiotics. 

Investigators concluded that switching from SAP to IAT is both safe and practical. OS or NRM had no significant drawbacks, and IAT resulted in lower antibiotic usage.

Source: pubmed.ncbi.nlm.nih.gov/39237814/