Rifaximin use favoured micafungin-resistant Candida spp. infections in recipients of allogeneic hematopoietic cell transplantation

Damage to gut mucosa following conditioning regimens may favour bacterial infections that can trigger graft versus host disease (GvHD) in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Rifaximin, an oral and non-absorbable antibiotic, has been recently proposed as eff...

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Bibliographic Details
Published in:Annals of hematology 2021-09, Vol.100 (9), p.2375-2380
Main Authors: Marzuttini, Francesca, Mancusi, Antonella, Bonato, Samanta, Griselli, Mario, Tricarico, Sara, Casarola, Genni, Paradiso, Matteo, Ruggeri, Loredana, Terenzi, Adelmo, Merluzzi, Mara, Prigitano, Anna, Tortorano, Anna Maria, Pitzurra, Lucia, Falini, Brunangelo, Carotti, Alessandra, Velardi, Andrea, Pierini, Antonio
Format: Article
Language:English
Subjects:
Antibiotics
Antifungal agents
Bacterial infections
Disease prevention
Graft versus host disease
Hematology
Infections
Medicine
Medicine & Public Health
Oncology
Original
Original Article
Stem cell transplantation
Transplants & implants
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Summary:Damage to gut mucosa following conditioning regimens may favour bacterial infections that can trigger graft versus host disease (GvHD) in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Rifaximin, an oral and non-absorbable antibiotic, has been recently proposed as effective prophylaxis to reduce bacterial infections in the gut and consequently acute GvHD in this setting. The present study evaluated safety and outcomes of HSCT patients that were treated with rifaximin prophylaxis at Perugia University Hospital. Rifaximin prophylaxis was introduced as standard of care in HSCT patients in May 2018. We retrieved data from 118 consecutive transplants, and we compared the outcomes of rifaximin-treated patients with historical controls that did not receive antibiotic prophylaxis. While incidences of neutropenic fever, documented bacterial infections, and aGvHD were similar in the two groups, we found an increased frequency of invasive candidiasis and clinically relevant Candida spp. infections in rifaximin-treated patients (5 patients vs 1 patient, 25% [± 0.99%] vs 1% [± 0.01%], p 
ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-021-04569-x