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Multicenter Study
. 2024 Mar 11;14(1):5947.
doi: 10.1038/s41598-024-56336-3.

Effective treatment of Clostridioides difficile infection improves survival and affects graft-versus-host disease: a multicenter study by the Polish Adult Leukemia Group

Agnieszka Piekarska  1 , Alicja Sadowska-Klasa  2 , Patrycja Mensah-Glanowska  3 , Małgorzata Sobczyk-Kruszelnicka  4 , Joanna Drozd-Sokołowska  5 , Anna Waszczuk-Gajda  5 , Joanna Kujawska  6 , Mateusz Wilk  7 , Agnieszka Tomaszewska  5 , Jan M Zaucha  2 , Sebastian Giebel  4 , Lidia Gil  6
Affiliations
Multicenter Study

Effective treatment of Clostridioides difficile infection improves survival and affects graft-versus-host disease: a multicenter study by the Polish Adult Leukemia Group

Agnieszka Piekarska et al. Sci Rep. .

Abstract

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.

Keywords: Clostridioides difficile infection; Allogeneic hematopoietic cell transplantation; Graft-versus-host disease; Metronidazole; Vancomycin.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Efficacy of the first-line treatment of Clostridioides difficile infection. The columns present absolute numbers of patients who responded (first column—cure) and did not respond (second column—failure) to metronidazole, vancomycin, or combination therapy, respectively.
Figure 2
Figure 2
Overall survival (a) and non-relapse mortality (b) after allogeneic hematopoietic cell transplantation depending on the type of therapy.
Figure 3
Figure 3
Overall survival depending on the efficacy of the first-line treatment.
See this image and copyright information in PMC

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