Oral Antibiotic Can Prevent C. difficile Infections in Stem Cell Recipients

Clostridium difficile (C. difficile) infection is the most common infectious complication experienced by patients undergoing stem cell transplants. Specifically, 30% of C. difficile infections can occur in allogeneic hematopoietic stem cell (alloHCT) transplants.

Researchers at the American Society of Hematology’s (ASH) 58^th Annual Meeting and Exposition explained they sought to assess whether oral vancomycin — a standard antibiotic used to treat C. difficile — could be administered to these stem cell patients as a preventative method.

Patients undergoing alloHCT receive their stem cells from healthy donors following high-intensity chemotherapy. These transplants require patients’ immune systems to be suppressed, making them at high risk for complicated infections.

To assess the antibiotic’s efficacy, Alex Ganetsky, PharmD, clinical pharmacist in the Blood and Marrow Transplantation Program in the Abramson Cancer Center at the University of Pennsylvania, and team conducted a study with 105 consecutive adults undergoing alloHCT between April 2015 and July 2016. All of the patients had received 125mg of oral vancomycin twice daily from the day of inpatient admission for alloHCT until the date of discharge.

The study findings were significant — none of the 73 patients administered oral vancomycin prior to their inpatient admission for the stem cell transplants developed C. difficile (33-day period). In the second group of 55 patients who didn’t receive the drug in advance, 11 developed the infection.

The team underlined that although the results showed the antibiotic was successful in preventing C. difficile infections, the overall length of hospitalization remained the same.

Because of these promising results, researchers did consider the idea of expanding the process of prophylactically administering oral vancomycin to patients with acute leukemia hospitalized for other types of treatment. However, with the rise of antibiotic resistance, the team hopes to target best practices to avoid overuse.

“The results are encouraging,” said Ganetsky. “This may become the standard of care at Penn among patients receiving allogeneic stem cell transplants.” Future studies will specifically aim evaluate patients’ length of hospital stay.

The study results were reported in the abstract Oral Vancomycin is Highly Effective in Preventing Clostridium Difficile Infection in Allogeneic Hematopoietic Stem Cell Transplant Recipients presented at ASH 2016.

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