title: Rifaximin preserves intestinal microbiota balance in patients undergoing allogeneic stem cell transplantation.
abstract: Intestinal dysbiosis has been associated with acute gastrointestinal GvHD and poor outcome following allogeneic stem cell transplantation (ASCT). To assess the effect of a switch in 2012 from ciprofloxacin/metronidazole to rifaximin for gut decontamination on intestinal microbiota composition and ASCT outcome, we retrospectively analyzed 394 patients receiving ASCT from September 2008 through June 2015. In 131 and 90 patients, respectively, urinary 3-indoxyl sulfate levels and intestinal enterococcal load were measured before conditioning and weekly within the first 28 days after ASCT. The use of rifaximin correlated with lower enterococcal positivity (6.9 vs 21.9%, P=0.05) and higher urinary 3-indoxyl sulfate concentrations (10.5 vs 4.6 μmoL/mmoL crea, P<0.001) after ASCT. Patients on rifaximin showed lower 1-year transplant-related mortality (P=0.04) and higher overall survival (P=0.008). Treatment of infectious complications with systemic antibiotics did not abrogate the beneficial effects of rifaximin on intestinal microbiota composition in the early course of ASCT and outcome. The data underscore the importance of maintaining a diverse population of symbiotic and mutualistic bacteria in the gut on ASCT outcome.
authors.affiliation: Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Weber
authors.affiliation: Chair and Institute of Functional Genomics, University of Regensburg, Regensburg, Germany.
authors.forename: P J
authors.initials: PJ
authors.lastname: Oefner
authors.affiliation: Chair and Institute of Functional Genomics, University of Regensburg, Regensburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Dettmer
authors.affiliation: Institute of Clinical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hiergeist
authors.affiliation: Institute of Clinical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Koestler
authors.affiliation: Institute of Clinical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gessner
authors.affiliation: Department of Orthopedic Surgery, University Medical Center, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.affiliation: Chair of Statistical Bioinformatics, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Stämmler
authors.affiliation: Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hahn
authors.affiliation: Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Wolff
authors.affiliation: Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Herr
authors.affiliation: Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Holler
mesh_terms: D000328:Adult; D016983:Enterococcus / Q000187:drug effects; D005260:Female; D005767:Gastrointestinal Diseases / Q000517:prevention & control; D000069196:Gastrointestinal Microbiome / Q000187:drug effects*; D006086:Graft vs Host Disease / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007200:Indican / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012294:Rifamycins / Q000008:administration & dosage* / Q000494:pharmacology; D000078262:Rifaximin; D016019:Survival Analysis; D014184:Transplantation, Homologous
chemical_list: D012294:Rifamycins; D000078262:Rifaximin; D007200:Indican