Piekarska Agnieszka, Sadowska-Klasa Alicja, Mensah-Glanowska Patrycja, Sobczyk-Kruszelnicka Małgorzata, Drozd-Sokołowska Joanna, Waszczuk-Gajda Anna, Kujawska Joanna, Wilk Mateusz, Tomaszewska Agnieszka, Zaucha Jan M, Giebel Sebastian, Gil Lidia
Department of Hematology and Transplantology, Medical University of Gdańsk and University Clinical Center, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland.
Department of Hematology, Jagiellonian University Collegium Medicum, University Hospital in Cracow, Cracow, Poland.
Sci Rep. 2024 Mar 11;14(1):5947. doi: 10.1038/s41598-024-56336-3.
Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea after allogeneic hematopoietic cell transplantation (allo-HCT). The impact of CDI and its treatment on allo-HCT outcomes and graft-versus-host disease (GVHD), including gastrointestinal GVHD (GI-GVHD) is not well established. This multicenter study assessed real-life data on the first-line treatment of CDI and its impact on allo-HCT outcomes. Retrospective and prospective data of patients with CDI after allo-HCT were assessed. We noted statistically significant increase in the incidence of acute GVHD and acute GI-GVHD after CDI (P = 0.005 and P = 0.016, respectively). The first-line treatment for CDI included metronidazole in 34 patients, vancomycin in 64, and combination therapy in 10. Treatment failure was more common with metronidazole than vancomycin (38.2% vs. 6.2%; P < 0.001). The need to administer second-line treatment was associated with the occurrence or exacerbation of GVHD (P < 0.05) and GI-GVHD (P < 0.001) and reduced overall survival (P < 0.05). In the multivariate analysis, the risk of death was associated with acute GVHD presence before CDI (hazard ratio [HR], 3.19; P = 0.009) and the need to switch to second-line treatment (HR, 4.83; P < 0.001). The efficacy of the initial CDI treatment affects survival and occurrence of immune-mediated GI-GVHD after allo-HCT. Therefore, agents with higher efficacy than metronidazole (vancomycin or fidaxomicin) should be administered as the first-line treatment.
艰难梭菌感染（CDI）是异基因造血细胞移植（allo-HCT）后感染性腹泻的最常见原因。CDI及其治疗对allo-HCT结局和移植物抗宿主病（GVHD），包括胃肠道GVHD（GI-GVHD）的影响尚未完全明确。这项多中心研究评估了CDI一线治疗的实际数据及其对allo-HCT结局的影响。对allo-HCT后CDI患者的回顾性和前瞻性数据进行了评估。我们注意到CDI后急性GVHD和急性GI-GVHD的发生率有统计学意义的增加（分别为P = 0.005和P = 0.016）。CDI的一线治疗包括34例患者使用甲硝唑，64例使用万古霉素，10例使用联合治疗。甲硝唑治疗失败比万古霉素更常见（38.2%对6.2%；P < 0.001）。给予二线治疗的必要性与GVHD（P < 0.05）和GI-GVHD（P < 0.001）的发生或加重以及总生存期降低（P < 0.05）相关。在多变量分析中，死亡风险与CDI前存在急性GVHD（风险比[HR]，3.19；P = 0.009）以及需要改用二线治疗（HR，4.83；P < 0.001）相关。初始CDI治疗的疗效影响allo-HCT后免疫介导的GI-GVHD的生存和发生。因此，应给予比甲硝唑疗效更高的药物（万古霉素或非达霉素）作为一线治疗。
