“The antibiotic paradox” in allogeneic stem cell transplantation

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Blood stream infections (BSI) significantly increase mortality in allogeneic stem cell transplantation (ASCT) patients, affecting 13-30% of recipients.
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Early and prolonged antibiotic use in ASCT leads to intestinal dysbiosis, increasing the risk of acute gastrointestinal Graft-versus-Host Disease (GvHD) and mortality.
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The antibiotic paradox arises as antibiotics can both harm beneficial microbiota and suppress translocated bacteria that trigger GvHD, complicating treatment outcomes.
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Dysbiosis erodes T-cell regulation, increasing GvHD susceptibility, while suppression of translocated bacteria may dampen T-cell activation and mitigate GvHD.
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Implementing restrictive antibiotic protocols and improving diagnostic strategies may reduce antibiotic exposure and minimize dysbiosis risk in ASCT patients.

Bone Marrow Transplantation

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
September 4, 2025

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