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Rethinking Antimicrobial Prophylaxis in the Transplant Patient in the World of Emerging Resistant Organisms—Where Are We Today?

  • Stem Cell Transplantation (R Maziarz, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The use of prophylactic antibiotics during the neutropenic period in hematopoietic stem cell transplantation has been the standard of care at most institutions for the past 20 years. We sought to review the benefits and risks of this practice.

Recent Findings

Emerging data has highlighted the potential costs of antibacterial prophylaxis, from selecting for antibiotic resistance to perturbing the microbiome and contributing to increase risk for Clostridium difficile and perhaps graft-versus-host-disease, conditions which may lead to poorer outcomes.

Summary

Though in many studies prophylactic antibiotics improved morbidity and mortality outcomes, the potential harms including antibiotic resistance, Clostridium difficile infection, and alterations of the gut microbiome should be considered. Future studies aimed to better risk-stratify patients and limit the use of broad-spectrum antibiotics are warranted.

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Abbreviations

BMT:

Bone marrow transplant

CDI:

Clostridium difficile infection

GVHD:

Graft-versus-host disease

HSCT:

Hematopoietic stem cell transplant

FMT:

Fecal microbiota transplant

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Authors and Affiliations

  1. Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0960, La Jolla, CA, 92093-0711, USA

    Lucy E. Horton & Randy A. Taplitz

  2. Department of Pharmacy, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0711, USA

    Nina M. Haste

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  1. Lucy E. Horton
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  2. Nina M. Haste
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  3. Randy A. Taplitz
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Correspondence to Randy A. Taplitz.

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Lucy E. Horton declares no potential conflicts of interest.

Nina M. Haste reports that spouse (Brandon Taylor, PhD) is employed by Novartis.

Randy A. Taplitz is on the advisory board for Merck.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Stem Cell Transplantation

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Horton, L.E., Haste, N.M. & Taplitz, R.A. Rethinking Antimicrobial Prophylaxis in the Transplant Patient in the World of Emerging Resistant Organisms—Where Are We Today?. Curr Hematol Malig Rep 13, 59–67 (2018). https://doi.org/10.1007/s11899-018-0435-0

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