Non-viral pathogens of infectious diarrhoea post-allogeneic stem cell transplantation are associated with graft-versus-host disease

Rees, MJ; Rivalland, A; Tan, S; Xie, M; Yong, MK; Ritchie, D

Author(s): Rees, MJ; Rivalland, A; Tan, S; Xie, M; Yong, MK; Ritchie, D;
Details: Publication Year 2024-02,Volume 103,Issue #2,Page 593-602
Journal Title: Annals of Hematology
Publication Type: Research article
Abstract: Infectious diarrhoea is common post-allogeneic haematopoietic stem-cell transplantation (alloHSCT). While the epidemiology of Clostridioides difficile infection (CDI) post-alloHSCT has been described, the impact of other diarrhoeal pathogens is uncertain. We reviewed all alloHSCT between 2017 and 2022 at a single large transplant centre; 374 patients were identified and included. The 1-year incidence of infectious diarrhoea was 23%, divided into viral (13/374, 3%), CDI (65/374, 17%) and other bacterial infections (16/374, 4%). There was a significant association between infectious diarrhoea within 1 year post-transplant and the occurrence of severe acute lower gastrointestinal graft-versus-host disease (GVHD, OR = 4.64, 95% CI 2.57-8.38, p < 0.001) and inferior GVHD-free, relapse-free survival on analysis adjusted for age, donor type, stem cell source and T-cell depletion (aHR = 1.64, 95% CI = 1.18-2.27, p = 0.003). When the classes of infectious diarrhoea were compared to no infection, bacterial (OR = 6.38, 95% CI 1.90-21.40, p = 0.003), CDI (OR = 3.80, 95% CI 1.91-7.53, p < 0.001) and multiple infections (OR = 11.16, 95% CI 2.84-43.92, p < 0.001) were all independently associated with a higher risk of severe GI GVHD. Conversely, viral infections were not (OR = 2.98, 95% CI 0.57-15.43, p = 0.20). Non-viral infectious diarrhoea is significantly associated with the development of GVHD. Research to examine whether the prevention of infectious diarrhoea via infection control measures or modulation of the microbiome reduces the incidence of GVHD is needed.
Publisher: Springer Nature
Keywords: Humans; Transplantation, Homologous/adverse effects; *Hematopoietic Stem Cell Transplantation/adverse effects; *Graft vs Host Disease/epidemiology/etiology/prevention & control; *Clostridium Infections/etiology; Diarrhea/epidemiology/etiology; Retrospective Studies; Clostrioides difficile infection; Graft-versus-host disease; Infectious diarrhoea; Retrospective review; Risk factors; Stem-cell transplantation
Department(s): Ambulatory Services; Clinical Haematology; Infectious Diseases
Publisher's Version: https://doi.org/10.1007/s00277-023-05526-6
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-02-20 07:04:48

Last Modified: 2024-02-20 07:05:27