Impact of Clostridioides Difficile Infection on Stem Cell Transplant Outcomes – Practical Considerations for Prevention and Treatment
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LEE, Jaewon; RAMANATHAN, Ramkarthic; RAMANATHAN, Muthalagu.
Impact of Clostridioides Difficile Infection on Stem Cell Transplant Outcomes – Practical Considerations for Prevention and Treatment.
Medical Research Archives, [S.l.], v. 13, n. 9, sep. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6929>. Date accessed: 08 jan. 2026.
doi: https://doi.org/10.18103/mra.v13i9.6929.
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Editorial
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Dubberke ER, Reske KA, Olsen MA, Bommarito KM, Seiler S, Silveira FP, et al. Risk for Clostridium difficile infection after allogeneic hematopoietic cell transplant remains elevated in the postengraftment period. Transplant Direct. 2017;3(4):e145.
2. Ramanathan M, Kim S, He N, Chen M, Hematti P, Abid MB, et al. The incidence and impact of Clostridioides difficile infection on transplant outcomes in acute leukemia and MDS after allogeneic hematopoietic cell transplant-a CIBMTR study. Bone Marrow Transplant. 2023;58(4):360-6.
3. Piekarska A, Sadowska-Klasa A, Mensah-Glanowska P, Sobczyk-Kruszelnicka M, Drozd-Sokołowska J, Waszczuk-Gajda A, et al. Effective treatment of Clostridioides difficile infection improves survival and affects graft-versus-host disease: a multicenter study by the Polish Adult Leukemia Group. Sci Rep. 2024;14(1):5947.
4. Alonso CD, Treadway SB, Hanna DB, Huff CA, Neofytos D, Carroll KC, et al. Epidemiology and outcomes of Clostridium difficile infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2012;54(8):1053-63.
5. Shah NN, McClellan W, Flowers CR, Lonial S, Khoury H, Waller EK, et al. Evaluating risk factors for Clostridium difficile infection in stem cell transplant recipients: a national study. Infect Control Hosp Epidemiol. 2017;38(6):651-7.
6. Weber S, Scheich S, Magh A, Wolf S, Enßle JC, Brunnberg U, et al. Impact of Clostridioides difficile infection on the outcome of patients receiving a hematopoietic stem cell transplantation. Int J Infect Dis. 2020;99:428-36.
7. Chen YH, Sun A-E, Narain K, Chang WC, Yang C, Chen PH, et al. Efficacy and safety of early antibiotic de-escalation in febrile neutropenia for patients with hematologic malignancy: a systematic review and meta-analysis. Antimicrob Agents Chemother. 2025;69(4):e0159724.
8. Gustinetti G, Raiola AM, Varaldo R, Galaverna F, Gualandi F, Del Bono V, et al. De-escalation and discontinuation of empirical antibiotic treatment in a cohort of allogeneic hematopoietic stem cell transplantation recipients during the pre-engraftment period. Biol Blood Marrow Transplant. 2018;24(8): 1721-6.
9. van Prehn J, Reigadas E, Vogelzang EH, Bouza E, Hristea A, Guery B, et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clin Microbiol Infect. 2021;27 Suppl 2:S1-s21.
10. Snyder M, Pasikhova Y, Baluch A. Early antimicrobial de-escalation and stewardship in adult hematopoietic stem cell transplantation recipients: retrospective review. Open Forum Infect Dis. 2017;4(4):ofx226.
11. Fusco B, Tomita-Barber J, Mazzaferro N, Tyno A, McEntee N, Greenberg P, et al. Prophylactic vancomycin in the primary prevention of Clostridium difficile in allogeneic stem cell transplant. Transpl Infect Dis. 2025;27(3):e70025.
12. Williams MJ, Atienza S, Franzen E, Rathod H, Mejaki B, Graff J, et al. Evaluation of primary oral vancomycin prophylaxis against Clostridioides difficile infection during autologous stem cell transplantation. Open Forum Infect Dis. 2024;11(11):ofae622.
13. Maraolo AE, Mazzitelli M, Zappulo E, Scotto R, Granata G, Andini R, et al. Oral vancomycin prophylaxis for primary and secondary prevention of Clostridioides difficile infection in patients treated with systemic antibiotic therapy: a systematic review, meta-analysis and trial sequential analysis. Antibiotics (Basel). 2022;11(2).
14. Peery AF, Kelly CR, Kao D, Vaughn BP, Lebwohl B, Singh S, et al. AGA Clinical Practice Guideline on Fecal Microbiota-Based Therapies for Select Gastrointestinal Diseases. Gastroenterology. 2024; 166(3):409-34.
15. DeFilipp Z, Hohmann E, Jenq RR, Chen YB. Fecal microbiota transplantation: restoring the injured microbiome after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2019;25(1):e17-e22.
16. Johnson S, Lavergne V, Skinner AM, Gonzales-Luna AJ, Garey KW, Kelly CP, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clinical Infectious Diseases. 2021;73(5):e1029-e44.
17. Bilinski J, Grzesiowski P, Sorensen N, Madry K, Muszynski J, Robak K, et al. Fecal microbiota transplantation in patients with blood disorders inhibits gut colonization with antibiotic-resistant bacteria: results of a prospective, single-center study. Clin Infect Dis. 2017;65(3):364-70.
18. Metafuni E, Di Marino L, Giammarco S, Bellesi S, Limongiello MA, Sorà F, et al. The role of fecal microbiota transplantation in the allogeneic stem cell transplant setting. Microorganisms. 2023;11(9).
19. Cammarota G, Ianiro G, Kelly CR, Mullish BH, Allegretti JR, Kassam Z, et al. International consensus conference on stool banking for faecal microbiota transplantation in clinical practice. Gut. 2019;68(12):2111-21.
20. Alsoubani M, Chow JK, Rodday AM, Kent D, Snydman DR. Comparative effectiveness of fidaxomicin vs vancomycin in populations with immunocompromising conditions for the treatment of Clostridioides difficile infection: a single-center study. Open Forum Infect Dis. 2024;11(1):ofad622.
21. Jiang Y, Sarpong EM, Sears P, Obi EN. Budget impact analysis of fidaxomicin versus vancomycin for the treatment of Clostridioides difficile infection in the United States. Infect Dis Ther. 2022;11(1):111-26.
22. Habibi S, Rashidi A. Fecal microbiota transplantation in hematopoietic cell transplant and cellular therapy recipients: lessons learned and the path forward. Gut Microbes. 2023;15(1):222 9567.
23. Kaźmierczak-Siedlecka K, Skonieczna-Żydecka K, Biliński J, Roviello G, Iannone LF, Atzeni A, et al. Gut microbiome modulation and faecal microbiota transplantation following allogenic hematopoietic stem cell transplantation. Cancers (Basel). 2021;13(18).
24. de Castro CG, Jr., Ganc AJ, Ganc RL, Petrolli MS, Hamerschlack N. Fecal microbiota transplant after hematopoietic SCT: report of a successful case. Bone Marrow Transplant. 2015;50(1):145.
25. Neemann K, Eichele DD, Smith PW, Bociek R, Akhtari M, Freifeld A. Fecal microbiota transplantation for fulminant Clostridium difficile infection in an allogeneic stem cell transplant patient. Transpl Infect Dis. 2012;14(6):E161-5.
2. Ramanathan M, Kim S, He N, Chen M, Hematti P, Abid MB, et al. The incidence and impact of Clostridioides difficile infection on transplant outcomes in acute leukemia and MDS after allogeneic hematopoietic cell transplant-a CIBMTR study. Bone Marrow Transplant. 2023;58(4):360-6.
3. Piekarska A, Sadowska-Klasa A, Mensah-Glanowska P, Sobczyk-Kruszelnicka M, Drozd-Sokołowska J, Waszczuk-Gajda A, et al. Effective treatment of Clostridioides difficile infection improves survival and affects graft-versus-host disease: a multicenter study by the Polish Adult Leukemia Group. Sci Rep. 2024;14(1):5947.
4. Alonso CD, Treadway SB, Hanna DB, Huff CA, Neofytos D, Carroll KC, et al. Epidemiology and outcomes of Clostridium difficile infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2012;54(8):1053-63.
5. Shah NN, McClellan W, Flowers CR, Lonial S, Khoury H, Waller EK, et al. Evaluating risk factors for Clostridium difficile infection in stem cell transplant recipients: a national study. Infect Control Hosp Epidemiol. 2017;38(6):651-7.
6. Weber S, Scheich S, Magh A, Wolf S, Enßle JC, Brunnberg U, et al. Impact of Clostridioides difficile infection on the outcome of patients receiving a hematopoietic stem cell transplantation. Int J Infect Dis. 2020;99:428-36.
7. Chen YH, Sun A-E, Narain K, Chang WC, Yang C, Chen PH, et al. Efficacy and safety of early antibiotic de-escalation in febrile neutropenia for patients with hematologic malignancy: a systematic review and meta-analysis. Antimicrob Agents Chemother. 2025;69(4):e0159724.
8. Gustinetti G, Raiola AM, Varaldo R, Galaverna F, Gualandi F, Del Bono V, et al. De-escalation and discontinuation of empirical antibiotic treatment in a cohort of allogeneic hematopoietic stem cell transplantation recipients during the pre-engraftment period. Biol Blood Marrow Transplant. 2018;24(8): 1721-6.
9. van Prehn J, Reigadas E, Vogelzang EH, Bouza E, Hristea A, Guery B, et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clin Microbiol Infect. 2021;27 Suppl 2:S1-s21.
10. Snyder M, Pasikhova Y, Baluch A. Early antimicrobial de-escalation and stewardship in adult hematopoietic stem cell transplantation recipients: retrospective review. Open Forum Infect Dis. 2017;4(4):ofx226.
11. Fusco B, Tomita-Barber J, Mazzaferro N, Tyno A, McEntee N, Greenberg P, et al. Prophylactic vancomycin in the primary prevention of Clostridium difficile in allogeneic stem cell transplant. Transpl Infect Dis. 2025;27(3):e70025.
12. Williams MJ, Atienza S, Franzen E, Rathod H, Mejaki B, Graff J, et al. Evaluation of primary oral vancomycin prophylaxis against Clostridioides difficile infection during autologous stem cell transplantation. Open Forum Infect Dis. 2024;11(11):ofae622.
13. Maraolo AE, Mazzitelli M, Zappulo E, Scotto R, Granata G, Andini R, et al. Oral vancomycin prophylaxis for primary and secondary prevention of Clostridioides difficile infection in patients treated with systemic antibiotic therapy: a systematic review, meta-analysis and trial sequential analysis. Antibiotics (Basel). 2022;11(2).
14. Peery AF, Kelly CR, Kao D, Vaughn BP, Lebwohl B, Singh S, et al. AGA Clinical Practice Guideline on Fecal Microbiota-Based Therapies for Select Gastrointestinal Diseases. Gastroenterology. 2024; 166(3):409-34.
15. DeFilipp Z, Hohmann E, Jenq RR, Chen YB. Fecal microbiota transplantation: restoring the injured microbiome after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2019;25(1):e17-e22.
16. Johnson S, Lavergne V, Skinner AM, Gonzales-Luna AJ, Garey KW, Kelly CP, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clinical Infectious Diseases. 2021;73(5):e1029-e44.
17. Bilinski J, Grzesiowski P, Sorensen N, Madry K, Muszynski J, Robak K, et al. Fecal microbiota transplantation in patients with blood disorders inhibits gut colonization with antibiotic-resistant bacteria: results of a prospective, single-center study. Clin Infect Dis. 2017;65(3):364-70.
18. Metafuni E, Di Marino L, Giammarco S, Bellesi S, Limongiello MA, Sorà F, et al. The role of fecal microbiota transplantation in the allogeneic stem cell transplant setting. Microorganisms. 2023;11(9).
19. Cammarota G, Ianiro G, Kelly CR, Mullish BH, Allegretti JR, Kassam Z, et al. International consensus conference on stool banking for faecal microbiota transplantation in clinical practice. Gut. 2019;68(12):2111-21.
20. Alsoubani M, Chow JK, Rodday AM, Kent D, Snydman DR. Comparative effectiveness of fidaxomicin vs vancomycin in populations with immunocompromising conditions for the treatment of Clostridioides difficile infection: a single-center study. Open Forum Infect Dis. 2024;11(1):ofad622.
21. Jiang Y, Sarpong EM, Sears P, Obi EN. Budget impact analysis of fidaxomicin versus vancomycin for the treatment of Clostridioides difficile infection in the United States. Infect Dis Ther. 2022;11(1):111-26.
22. Habibi S, Rashidi A. Fecal microbiota transplantation in hematopoietic cell transplant and cellular therapy recipients: lessons learned and the path forward. Gut Microbes. 2023;15(1):222 9567.
23. Kaźmierczak-Siedlecka K, Skonieczna-Żydecka K, Biliński J, Roviello G, Iannone LF, Atzeni A, et al. Gut microbiome modulation and faecal microbiota transplantation following allogenic hematopoietic stem cell transplantation. Cancers (Basel). 2021;13(18).
24. de Castro CG, Jr., Ganc AJ, Ganc RL, Petrolli MS, Hamerschlack N. Fecal microbiota transplant after hematopoietic SCT: report of a successful case. Bone Marrow Transplant. 2015;50(1):145.
25. Neemann K, Eichele DD, Smith PW, Bociek R, Akhtari M, Freifeld A. Fecal microbiota transplantation for fulminant Clostridium difficile infection in an allogeneic stem cell transplant patient. Transpl Infect Dis. 2012;14(6):E161-5.