Discrepancies in the management of Clostridioides difficile infections in patients after allogeneic haematopoietic cell transplantation: the results of the Infectious Diseases Working Party EBMT survey

Impact of Clostridioides difficile infection on survival and graft-versus-host disease after allogeneic hematopoietic cell transplantation: a multicenter study on behalf of the Polish Adult Leukemia Group

“…Despite the clear evidence from research, a survey performed by IDWP-EBMT revealed that oral vancomycin or metronidazole was used as the rst-line treatment for nonsevere CDI in 49.3% and 45.8% of EBMT centers, respectively, and for severe CDI, in 59.7% and 30.6% of the centers, respectively. [17] Our study provides further evidence to encourage transplant centers to follow the latest guidelines of the IDSA/SHEA and ASCTC. [16,15] Low treatment e cacy patients receiving combination therapy in our study can be explained by a more severe manifestation of CDI in these patients.…”

“…[15,16] Despite these recommendations, a recent survey by the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation (IDWP-EBMT) revealed that metronidazole was used in numerous transplant centers, even in severe or recurrent CDI. [17] According to pharmacokinetic data, oral vancomycin achieves the higher activity than metronidazole in the colon due its poor absorption. [18,19] Additionally, antibiotics unselectively targeting Clostridiales strains bene cial for Tregulatory cell formation may enhance pro-in ammatory processes in the guts leading to the development of graft-versus-host disease (GVHD) or to disease exacerbations if GVHD was present before CDI.…”

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

“…In the metronidazole group, 29% of patients required a switch to vancomycin due to persistent symptoms. Despite the clear evidence from research, a survey performed by IDWP-EBMT revealed that oral vancomycin or oral metronidazole was used as the first-line treatment for nonsevere CDI in 49.3% and 45.8% of EBMT centers, respectively, and for severe CDI, in 59.7% and 30.6% of the centers, respectively 17 . Our study provides further evidence to encourage transplant centers to follow the latest guidelines of the IDSA/SHEA and ASCTC 15 , 16 .…”

“…Despite these recommendations, a recent survey by the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation (IDWP-EBMT) revealed that metronidazole was used in numerous transplant centers, even in severe or recurrent CDI 17 . According to pharmacokinetic data, oral vancomycin achieves the higher activity than metronidazole in the colon due its poor absorption 18 , 19 .…”