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  1. Stan Deresinski, Section Editor

Would Sparing the Anaerobes Prevent Graft-Versus-Host Disease–Related Mortality?

Shono Y, Docampo MD, Peled JU, et al. Increased GVHD-related mortality with broad-spectrum antibiotic use after allogeneic hematopoietic stem cell transplantation in human patients and mice. Sci Transl Med 2016; 8:339ra71. doi:10.1126/scitranslmed.aaf2311.

Narrowed diversity of the intestinal microbiome is associated with an increased risk of mortality in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients [1]. Holler and colleagues previously found that major shifts in the makeup of the microbiome, including loss of diversity, occurs early in the course of transplantation in association with antibiotic treatment, often given for febrile neutropenia [2]. Among the causes of the increased mortality is graft-vs-host disease (GVHD). Unfortunately, allo-HSCT recipients cannot escape exposure to broad-spectrum antibiotics, many of which drastically affect the anaerobic intestinal bacterial flora. Shono and colleagues examined the hypothesis that use of an antibiotic that relatively spares anaerobic commensals is associated with a reduced risk of severe GVHD.

The investigators evaluated 857 adult allo-HSCT recipients (recipients of T-cell–depleted grafts were excluded) seen over 13 years at their center. The overall 5-year GVHD-related mortality was 14.9%. They identified the 12 most frequently administered antibiotics given from 7 days before through 28 days after transplantation. They found that the 2 antibiotics with the greatest association with GVHD-related mortality when comparing recipients to nonrecipients of each antibiotic were piperacillin-tazobactam (P = .007) and imipenem-cilastatin (P = .025). No other antibiotic was significantly associated with this complication, and 2 antibiotics that are frequently used in empiric therapy in these patients and which have limited antianaerobe activity, cefepime …

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