601Antibiotic Use Patterns Early After Hematopoietic Cell Transplantation (HCT) Influence the Risk of Viral Infections and Acute Graft-Versus-Host Disease (GVHD)
Year: 2014
Type: conference-abstract
Abstract: Background. Recent data suggest that antibiotic therapy produces changes in the gut microbiome that may play a key role in modulating infectious risk after HCT: domination of the gut microbiota early after HCT was dependent on exposure to certain antibiotics and the abundance of bacterial species drastically increases the risk of subsequent bloodstream infections and possibly GVHD (Clin Inf Dis 55:205, 2012, J Exp Med 209:903, 2012). The absence of Gram-positive Firmicutes has been suggested to increase the risk of GVHD. Moreover, the risk of viral disease appears to be influenced by the microbiome via modulation of innate and adaptive immune responses (Immunol Rev 245:209, 2012). Here we examined whether antibiotic use early after HCT affects the risk of viral infections and acute GVHD. Methods. We evaluated one of our previously published, well-characterized cohorts of HCT recipients (BMT 45:675, 2010). We categorized (i) the use of antibiotics with activity against Gram-positive Firmicutes (vancomycin, clindamycin) and (ii)quantified the use of all classes of antibiotics during the first 25 days after HCT (‘day-25 antibiotic burden’). In landmark analyses among day-25 survivors (N = 362) using Cox proportional hazard models, we then correlated vancomycin/clindamycin use or ‘day-25 antibiotic burden’ with risks of respiratory virus infection, CMV disease and acute GVHD occurring beyond 25 days from HCT. Results. Table 1 shows the effects of antibiotic use patterns on respiratory virus infection, CMV disease, and acute GVHD. Vancomycin/clindamycin use was associated with an increased risk of respiratory virus infections and severe acute GVHD (grade 3-4). Day-25 antibiotic burden was associated with both viral infections (respiratory viruses, CMV) and severe acute GVHD. Conclusion. These results show that antibiotic use patterns early after HCT are associated with risk of viral infections and acute GVHD. Further studies aimed at examining how antibiotics affect the gut microbiota composition and diversity, innate and adaptive immune responses, and subsequent viral disease and GVHD risk are warranted. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Institution: Fred Hutch Cancer Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2256528053