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Review
. 2018 Feb;13(1):59-67.
doi: 10.1007/s11899-018-0435-0.

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

Lucy E Horton  1 , Nina M Haste  2 , Randy A Taplitz  3
Affiliations
Review

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

Lucy E Horton et al. Curr Hematol Malig Rep. 2018 Feb.

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. 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.

Keywords: Antibiotic prophylaxis; Bone marrow transplant (BMT); Graft-versus-host-disease (GVHD), microbiome; Hematopoietic stem cell transplant (HSCT); Neutropenia.

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Conflict of interest statement

Conflict of Interest 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.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
a The benefits and risks of antibiotic prophylaxis in neutropenia. b Strategic determination of individual risk using ecological, treatment-related, and patient-specific factors
See this image and copyright information in PMC

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