Clostridioides difficile infection in the allogeneic hematopoietic cell transplant recipient.
Davide Lo PortoAlessandra MularoniElio CastagnolaCarolina SaffiotiPublished in: Transplant infectious disease : an official journal of the Transplantation Society (2023)
Clostridioides difficile (CD) is one of the most important causes of diarrhea in hospitalized patients, in particular those who undergo an allogeneic hematopoietic cell transplant (allo-HCT) and who are more at risk of developing a CD infection (CDI) due to frequent hospitalizations, iatrogenic immunosuppression, and prolonged antibiotic cycles. CDI may represent a severe condition in allo-HCT patients, increasing the length of hospitalization, influencing the intestinal microbiome with a bidirectional association with graft-versus-host disease, and leading to unfavorable outcomes, including death. The diagnosis of CDI requires the exclusion of other probable causes of diarrhea in HCT patients and is based on highly sensitive and highly specific tests to distinguish colonization from infection. In adult patients, fidaxomicin is recommended as first-line, with oral vancomycin as an alternative agent. Bezlotoxumab may be used to reduce the risk of recurrence. In pediatric patients, vancomycin and metronidazole are still suggested as first-line therapy, but fidaxomicin will probably become standard in pediatrics in the near future. Because of insufficient safety data, fecal microbiota transplantation is not routinely recommended in HCT in spite of promising results for the management of recurrences in other populations.
Keyphrases
- clostridium difficile
- end stage renal disease
- bone marrow
- stem cell transplantation
- chronic kidney disease
- newly diagnosed
- ejection fraction
- cell therapy
- peritoneal dialysis
- prognostic factors
- single cell
- metabolic syndrome
- low dose
- stem cells
- cell death
- staphylococcus aureus
- high resolution
- electronic health record
- artificial intelligence
- current status
- cell proliferation
- single molecule
- signaling pathway
- high dose
- drug induced
- pi k akt
- free survival