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Interventional antibiotic treatment vs systemic antibiotic prophylaxis in patients undergoing allo-HSCT
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SAP during neutropenia is commonly used in patients undergoing allo-HSCT to reduce the risk of BSI. However, this approach can disrupt the intestinal microbiome, increasing the risk of GvHD and colonization with multidrug-resistant organisms.1 A retrospective analysis assessed the safety and efficacy of IAT in adult patients undergoing allo-HSCT (n = 68) compared with SAP-treated patients (n = 67). Results from this analysis were published in Annals of Hematology by Toenges et al.1
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| Key learnings: |
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IAT was associated with a shorter median duration of antibiotic treatment (18 days vs 24 days) compared with SAP, resulting in lower patient antibiotic exposure (p = 0.0001). |
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IAT was linked with a higher cumulative incidence of BSI in the first 100 days post-transplant vs SAP (40% vs 13%; p < 0.001), but did not impact OS at 3 years (66% vs 68.9%), increase NRM at 3 years (10.96% vs 9.75%), or result in ICU admissions (13% vs 6%), supporting the safety of the IAT approach. |
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The cumulative incidence of acute GvHD Grade 2–4 at 100 days (38.71% vs 29.85%; p = 0.307) and chronic GvHD of any grade at 3 years (44.75% vs 50.01%; p = 0.952) was similar between the IAT and SAP groups, although there was a trend toward less severe chronic GvHD in the IAT cohort (13.46% vs 27.86%; p = 0.098), suggesting a potential benefit of microbiome preservation. |
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The findings suggest that replacing SAP with IAT is safe and feasible in clinical practice, providing an opportunity to limit antibiotic exposure without compromising outcomes in patients undergoing allo-HSCT. However, larger, prospective studies are warranted to confirm this potential benefit. |
Abbreviations: allo-HSCT, allogeneic hematopoietic stem cell transplantation; BSI, bloodstream infections; GvHD, graft-versus-host disease; IAT, interventional antibiotic treatment; ICU, intensive care unit; NRM, non-relapse mortality; OS, overall survival; SAP, systemic antibiotic prophylaxis.
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