Preventing C. Diff in Patients With Blood Cancer Undergoing Bone Marrow Transplant

Clostridium difficile infection, commonly known as C. diff. is the most common and costly infection for hospitalized patients undergoing bone marrow transplantation for the treatment of blood cancer. However, a recent study found that the standard antibiotic treatment for the infection, oral vancomycin, may be able to prevent the occurrence of C. diff.

C. diff causes diarrhea and can lead to severe inflammation of the bowel. The infection is uncomfortable and can result in other severe medical complications, along with longer hospital stays and increased treatment costs. Last year, the American Journal of Gastroenterology published a paper that calculated the average costs of C. diff to range from $8911 to $30,049 per patient.

In the trial, which was conducted at the Abramson Cancer Center at the University of Pennsylvania, researchers gave vancomycin to 73 patients on a preventive basis—twice daily from the day of admission until the day of discharge. They focused on patients with blood cancer undergoing allogeneic stem cell transplants. These patients have their immune systems repressed so as not to reject the bone marrow from the healthy donor. However, this leaves patients at a high risk of life-threatening infections.

Of the 73 patients who received vancomycin prophylactically, none of them developed C. diff within their stay at the hospital—an average length of 33 days. Of the 55 patients studied who did not receive the vancomycin, 11 (20 percent) developed the C. diff infection. This result is on par with the national average of between 20 percent and 30 percent.

“This is the first study to evaluate this preventative strategy in stem cell transplant recipients, and the results are encouraging. This may become the standard of care at Penn among patients receiving allogeneic stem cell transplants,” lead author Alex Ganetsky, Pharm.D., clinical pharmacist in the Blood and Marrow Transplantation Program at Abramson, said in a statement.

Ganetsky added that this strategy could potentially be used in other populations, for example, patients with acute leukemia who are being hospitalized for other types of treatments could potentially be the next to be evaluated.

However, researchers want to be sure to pinpoint the best use of this drug through further study, to avoid overuse and antibiotic resistance.

“What we want to do is maximize the appropriate use of antibiotics,” explained David Porter, M.D., the study’s senior author, in a statement. He is director of Blood and Marrow Transplantation, Jodi Fisher Horowitz Professor in Leukemia Care Excellence in the Abramson Cancer Center.

“With our control group showing a 20 percent infection rate, that means we’re giving the antibiotics to a lot of people who would not have otherwise developed C. diff, but given the risks associated with the condition for these patients, our results demonstrate a potential path to protecting more of them during a very vulnerable period in their recovery.”

Porter went on to highlight the importance of the multidisciplinary approach deployed in this study. Different perspectives from doctors, pharmacists, and other clinicians can come together to bring added benefits to patient care.