To explore the paradoxical effects of antibiotic treatment on outcomes in allogeneic stem cell transplantation (ASCT), particularly regarding its impact on gut microbiota and Graft-versus-Host Disease (GvHD), emphasizing the dual nature of antibiotics.
Key Findings:
BSI occurs in 13-30% of ASCT recipients, increasing mortality, underscoring the need for careful antibiotic management.
Prolonged antibiotic use leads to intestinal dysbiosis, loss of protective bacteria, and increased risk of acute GvHD, highlighting the paradox.
Dysbiosis correlates with worse outcomes, primarily due to elevated GvHD risk, necessitating a reevaluation of antibiotic protocols.
Antibiotics can both enhance and suppress T-cell mediated immunity depending on timing and context, illustrating the complexity of treatment strategies.
Interpretation:
The findings highlight a complex relationship between antibiotic use, gut microbiota, and immune responses in ASCT, suggesting that while antibiotics are necessary for infection control, their prolonged use can lead to detrimental effects on patient outcomes, warranting a balanced approach.
Limitations:
Current clinical practices often do not adhere to guidelines for antibiotic de-escalation, which may lead to unnecessary prolonged exposure.
Lack of simple laboratory markers to differentiate between fever causes complicates antibiotic management, indicating a need for better diagnostic tools.
Conclusion:
Adhering to antibiotic stewardship and improving diagnostic strategies may reduce dysbiosis and enhance outcomes in ASCT patients, while further research is needed to clarify the optimal use of antibiotics in this context, particularly regarding timing and duration.
by Daniela Weber, Elisabeth Meedt, Sakhila Ghimire, Andreas Hiergeist, Michael A. G. Kern, Matthias Höpting, Erik Thiele Orberg, Haroon Shaikh, Andreas Beilhack, Daniel Wolff, Matthias Edinger, Wolfgang Herr, Andre Gessner, Hendrik Poeck, Ernst Holler
