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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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| Published in: | Annals of hematology 2021-09, Vol.100 (9), p.2375-2380 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1007/s00277-021-04569-x |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8357665</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2560161784</sourcerecordid><originalsourceid>FETCH-LOGICAL-c451t-9ba24bd9a6d94b05606edc27be4fdfa70a9835212e5bb8c0d8fdfd8f14cf63d3</originalsourceid><addsrcrecordid>eNp9kU1rHSEUhqU0NLdJ_kBXQtem6jhfm0K59AsChZK9OHq8MczoVJ1wu-0v70luaOmmLvSo7_N68CXkjeDXgvP-XeFc9j3jUjCu2m5kxxdkJ1QjGW8H9ZLs-NiMrMVxTl6Xcs-5kIOSr8h5o8SAcLMjv74Hb45hCZFuBag3D2nL4OgSrPFbPITIMpRQqomV7k10wRla1vWahujB1pBiwZJmsGENEGuhyVMzz-kAEYKld7CYmtYUoOLOwjzTmk0s64yO5pG_JGfezAWuntcLcvvp4-3-C7v59vnr_sMNs6oVlY2TkWpyo-ncqCbedrwDZ2U_gfLOm56bcWhaKSS00zRY7gY8xkko67vGNRfk_cl23aYFSew1m1mvOSwm_9TJBP3vTQx3-pAeNLr2Xdeiwdtng5x-bFCqvse_itiyltiN6EQ_KFTJk8rmVEoG_-cFwfVjbPoUm8bY9FNs-ohQc4IKiuMB8l_r_1C_AYt5n7E</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2560161784</pqid></control><display><type>article</type><title>Rifaximin use favoured micafungin-resistant Candida spp. infections in recipients of allogeneic hematopoietic cell transplantation</title><source>Springer Nature</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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 < .0001). Three rifaximin-treated patients experienced life-threating candidemia (2
C. krusei
, 1
C. orthopsilosis
). Rifaximin was the only factor that increased the risk of
Candida
spp. infections. Rifaximin could have contributed to microbiome disruption which favoured an outbreak of life-threatening
Candida
infections. This important complication forced us to halt its use. Larger, prospective studies are needed to assess the impact of rifaximin prophylaxis on incidence of bacterial infections, aGvHD, and survival of HSCT patients.</description><identifier>ISSN: 0939-5555</identifier><identifier>EISSN: 1432-0584</identifier><identifier>DOI: 10.1007/s00277-021-04569-x</identifier><identifier>PMID: 34180023</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>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</subject><ispartof>Annals of hematology, 2021-09, Vol.100 (9), p.2375-2380</ispartof><rights>The Author(s) 2021</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-9ba24bd9a6d94b05606edc27be4fdfa70a9835212e5bb8c0d8fdfd8f14cf63d3</citedby><cites>FETCH-LOGICAL-c451t-9ba24bd9a6d94b05606edc27be4fdfa70a9835212e5bb8c0d8fdfd8f14cf63d3</cites><orcidid>0000-0003-3518-0665</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids></links><search><creatorcontrib>Marzuttini, Francesca</creatorcontrib><creatorcontrib>Mancusi, Antonella</creatorcontrib><creatorcontrib>Bonato, Samanta</creatorcontrib><creatorcontrib>Griselli, Mario</creatorcontrib><creatorcontrib>Tricarico, Sara</creatorcontrib><creatorcontrib>Casarola, Genni</creatorcontrib><creatorcontrib>Paradiso, Matteo</creatorcontrib><creatorcontrib>Ruggeri, Loredana</creatorcontrib><creatorcontrib>Terenzi, Adelmo</creatorcontrib><creatorcontrib>Merluzzi, Mara</creatorcontrib><creatorcontrib>Prigitano, Anna</creatorcontrib><creatorcontrib>Tortorano, Anna Maria</creatorcontrib><creatorcontrib>Pitzurra, Lucia</creatorcontrib><creatorcontrib>Falini, Brunangelo</creatorcontrib><creatorcontrib>Carotti, Alessandra</creatorcontrib><creatorcontrib>Velardi, Andrea</creatorcontrib><creatorcontrib>Pierini, Antonio</creatorcontrib><title>Rifaximin use favoured micafungin-resistant Candida spp. infections in recipients of allogeneic hematopoietic cell transplantation</title><title>Annals of hematology</title><addtitle>Ann Hematol</addtitle><description>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 < .0001). Three rifaximin-treated patients experienced life-threating candidemia (2
C. krusei
, 1
C. orthopsilosis
). Rifaximin was the only factor that increased the risk of
Candida
spp. infections. Rifaximin could have contributed to microbiome disruption which favoured an outbreak of life-threatening
Candida
infections. This important complication forced us to halt its use. Larger, prospective studies are needed to assess the impact of rifaximin prophylaxis on incidence of bacterial infections, aGvHD, and survival of HSCT patients.</description><subject>Antibiotics</subject><subject>Antifungal agents</subject><subject>Bacterial infections</subject><subject>Disease prevention</subject><subject>Graft versus host disease</subject><subject>Hematology</subject><subject>Infections</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Original</subject><subject>Original Article</subject><subject>Stem cell transplantation</subject><subject>Transplants & implants</subject><issn>0939-5555</issn><issn>1432-0584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kU1rHSEUhqU0NLdJ_kBXQtem6jhfm0K59AsChZK9OHq8MczoVJ1wu-0v70luaOmmLvSo7_N68CXkjeDXgvP-XeFc9j3jUjCu2m5kxxdkJ1QjGW8H9ZLs-NiMrMVxTl6Xcs-5kIOSr8h5o8SAcLMjv74Hb45hCZFuBag3D2nL4OgSrPFbPITIMpRQqomV7k10wRla1vWahujB1pBiwZJmsGENEGuhyVMzz-kAEYKld7CYmtYUoOLOwjzTmk0s64yO5pG_JGfezAWuntcLcvvp4-3-C7v59vnr_sMNs6oVlY2TkWpyo-ncqCbedrwDZ2U_gfLOm56bcWhaKSS00zRY7gY8xkko67vGNRfk_cl23aYFSew1m1mvOSwm_9TJBP3vTQx3-pAeNLr2Xdeiwdtng5x-bFCqvse_itiyltiN6EQ_KFTJk8rmVEoG_-cFwfVjbPoUm8bY9FNs-ohQc4IKiuMB8l_r_1C_AYt5n7E</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Marzuttini, Francesca</creator><creator>Mancusi, Antonella</creator><creator>Bonato, Samanta</creator><creator>Griselli, Mario</creator><creator>Tricarico, Sara</creator><creator>Casarola, Genni</creator><creator>Paradiso, Matteo</creator><creator>Ruggeri, Loredana</creator><creator>Terenzi, Adelmo</creator><creator>Merluzzi, Mara</creator><creator>Prigitano, Anna</creator><creator>Tortorano, Anna Maria</creator><creator>Pitzurra, Lucia</creator><creator>Falini, Brunangelo</creator><creator>Carotti, Alessandra</creator><creator>Velardi, Andrea</creator><creator>Pierini, Antonio</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3518-0665</orcidid></search><sort><creationdate>20210901</creationdate><title>Rifaximin use favoured micafungin-resistant Candida spp. infections in recipients of allogeneic hematopoietic cell transplantation</title><author>Marzuttini, Francesca ; 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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 < .0001). Three rifaximin-treated patients experienced life-threating candidemia (2
C. krusei
, 1
C. orthopsilosis
). Rifaximin was the only factor that increased the risk of
Candida
spp. infections. Rifaximin could have contributed to microbiome disruption which favoured an outbreak of life-threatening
Candida
infections. This important complication forced us to halt its use. Larger, prospective studies are needed to assess the impact of rifaximin prophylaxis on incidence of bacterial infections, aGvHD, and survival of HSCT patients.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34180023</pmid><doi>10.1007/s00277-021-04569-x</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-3518-0665</orcidid><oa>free_for_read</oa></addata></record> |
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| issn | 0939-5555 1432-0584 |
| language | eng |
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| source | Springer Nature |
| 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 |
| title | Rifaximin use favoured micafungin-resistant Candida spp. infections in recipients of allogeneic hematopoietic cell transplantation |
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