Clostridioides difficile Infection in the Stem Cell Transplant and Hematologic Malignancy Population

Abstract

Clostridioides difficile infection (CDI) is common in the stem cell transplant (SCT) and hematologic malignancy (HM) population and mostly occurs in the early posttransplant period. Treatment of CDI in SCT/HM is the same as for the general population, with the exception that fecal microbiota transplant (FMT) has not been widely adopted because of safety concerns. Several case reports, small series, and retrospective studies have shown that FMT is effective and safe. A randomized controlled trial of FMT for prophylaxis of CDI in SCT patients is underway. In addition, an abundance of novel therapeutics for CDI is currently in development.

Keywords: Clostridioides (Clostridium) difficile; Graft-versus-host disease; Hematologic malignancy; Stem cell transplant.

Fig. 1.

Intestinal microbiota and colonization resistance. (A) In the healthy intestine, commensal bacteria convert primary bile acids into secondary bile acids, which inhibit the growth of CD. Commensal bacteria also convert carbohydrates into short-chain fatty acids (SCFAs), such as succinate, and produce sialidases that cleave sugars attached to gut epithelial cells and release sialic acid into the lumen. These molecules then serve as an energy source for the commensal bacteria. (B) Antibiotics deplete commensal bacterial populations, resulting in a buildup of primary bile acids that facilitate germination of CD spores. CD is then able to take advantage of the abundance of food sources (sialic acid and succinate) in the absence of competition from commensal bacterial communities.