Clostridium difficile: deleterious impact on hematopoietic stem cell transplantation

Area of Science:

• Infectious Diseases
• Hematology
• Transplantation Medicine

Background:

• Clostridioides difficile infection (CDI) is a significant cause of hospital-acquired diarrhea, particularly prevalent in hematopoietic stem cell transplantation (HSCT) recipients.
• Incidence rates of CDI in HSCT patients range from 6% to 20% within the first year post-transplant, with higher frequency observed after allogeneic HSCT (allo-HSCT).

Purpose of the Study:

• To review the current landscape of Clostridioides difficile infection in HSCT recipients.
• To discuss diagnostic strategies, clinical course, interactions with graft-versus-host disease (GVHD), and emerging treatment options for CDI post-HSCT.

Main Methods:

• Review of recent publications and clinical evidence regarding CDI in HSCT patients.
• Comparison of diagnostic methods, including enzyme immunoassays (EIA) and polymerase chain reaction (PCR) for toxin genes.
• Analysis of treatment modalities, including metronidazole, vancomycin, fidaxomicin, and fecal microbiota transplantation (FMT).

Main Results:

• Polymerase chain reaction (PCR) is increasingly favored over EIA for CDI diagnosis due to higher sensitivity, potentially increasing measured incidence.
• CDI typically manifests within the first month post-HSCT and may exacerbate graft-versus-host disease (GVHD) in allo-HSCT recipients.
• A reciprocal relationship exists between GVHD and CDI risk, where each condition can influence the incidence and severity of the other.

Conclusions:

• Metronidazole and combination therapy with metronidazole and oral vancomycin are common treatments for CDI post-HSCT.
• Fidaxomicin and fecal microbiota transplantation (FMT) represent promising, though less studied, therapeutic avenues for CDI in this patient population.
• Further investigation into newer treatment modalities like fidaxomicin and FMT is warranted for HSCT recipients experiencing CDI.