Intestinal Domination and the Risk of Bacteremia in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation
Open accessAbstract
BACKGROUND: Bacteremia is a frequent complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). It is unclear whether changes in the intestinal microbiota during allo-HSCT contribute to the development of bacteremia. We examined the microbiota of patients undergoing allo-HSCT, and correlated microbial shifts with the risk of bacteremia. METHODS: Fecal specimens were collected longitudinally from 94 patients undergoing allo-HSCT, from before transplant until 35 days after transplant. The intestinal microbiota was characterized by 454 pyrosequencing of the V1-V3 region of bacterial 16S ribosomal RNA genes. Microbial diversity was estimated by grouping sequences into operational taxonomic units and calculating the Shannon diversity index. Phylogenetic classification was obtained using the Ribosomal Database Project classifier. Associations of the microbiota with clinical predictors and outcomes were evaluated. RESULTS: During allo-HSCT, patients developed reduced diversity, with marked shifts in bacterial populations inhabiting the gut. Intestinal domination, defined as occupation of at least 30% of the microbiota by a single predominating bacterial taxon, occurred frequently. Commonly encountered dominating organisms included Enterococcus, Streptococcus, and various Proteobacteria. Enterococcal domination was increased 3-fold by metronidazole administration, whereas domination by Proteobacteria was reduced 10-fold by fluoroquinolone administration. As a predictor of outcomes, enterococcal domination increased the risk of Vancomycin-resistant Enterococcus bacteremia 9-fold, and proteobacterial domination increased the risk of gram-negative rod bacteremia 5-fold. CONCLUSIONS: During allo-HSCT, the diversity and stability of the intestinal flora are disrupted, resulting in domination by bacteria associated with subsequent bacteremia. Assessment of fecal microbiota identifies patients at highest risk for bloodstream infection during allo-HCST.
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This multicenter study extends earlier findings from smaller single-center cohorts.
“The results of this international study extend previous observations that have been made in smaller, single-center cohorts.3,4,8,36”
From Microbiota as Predictor of Mortality in Allogeneic Hematopoietic-Cell Transplantation (2020) · cites this paper as [3]
Single-center studies have linked post-HCT intestinal microbiota features to relapse, GVHD, infection, organ toxicity, and overall survival.
“Each of these outcomes, as well as overall survival, has been associated in single-center studies with features of the intestinal microbiota in the period after hematopoietic-cell transplantation.2–4,8–15”
From Microbiota as Predictor of Mortality in Allogeneic Hematopoietic-Cell Transplantation (2020) · cites this paper as [3]
Allogeneic HCT patients show microbiota disruption, including overgrowth of potential pathogens and reduced alpha diversity.
“We and others have reported that patients undergoing allogeneic hematopoietic-cell transplantation have microbiota disruption that is characterized by expansions of potentially pathogenic bacteria and loss of alpha diversity — a variable that reflects the number of unique bacterial taxa present and their relative frequencies.2–5”
From Microbiota as Predictor of Mortality in Allogeneic Hematopoietic-Cell Transplantation (2020) · cites this paper as [3]
When one bacterial taxon dominates the gut community, bloodstream infection with that same taxon becomes more likely.
“For example, domination of intestinal communities by a single bacterial taxon leads to an increased risk of bloodstream infection by a bacterium of that same taxon,3”
From Microbiota as Predictor of Mortality in Allogeneic Hematopoietic-Cell Transplantation (2020) · cites this paper as [3]
After allogeneic stem cell transplant, the gut microbiota loses diversity and stability and becomes dominated by Enterococcus, Streptococcus and Proteobacteria.
“a disruption of the existing state of equilibrium of the gut microbiota post-HSCT with a relative dysbiosis and a loss of bacterial diversity and stability and dominance of Enterococcus, Streptococcus and various Proteobacteria”
From The Influence of the Gut Microbiome on Cancer, Immunity, and Cancer Immunotherapy (2018) · cites this paper as Taur et al., 2012
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Self-citation
- Authors
- Taur, Y., Xavier, J. B., Lipuma, L., Ubeda, C., Goldberg, J., Gobourne, A., Lee, Y. J., Dubin, K. A., Socci, N. D., Viale, A., Perales, M.-A., Jenq, R. R., van den Brink, M. R. M., & Pamer, E. G.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Corresponding author
- Taur, Ying
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-06-20
- Volume
- 55
- Issue
- 7
- Pages
- 905-914
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC3657523
- OpenAlex
- W2139284253
- Cited by
- 1,020
- References
- 44
- Citations by year
- 2026: 77 · 2025: 71 · 2024: 78 · 2023: 91 · 2022: 107 · 2021: 103 · 2020: 112 · 2019: 98 · 2018: 57 · 2017: 58 · 2016: 66 · 2015: 49 · 2014: 27 · 2013: 23 · 2012: 2
- FWCI
- 12.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Tow Foundation
- National Institutes of Health (1k23ai095398-01, DP2OD008440)
- National Cancer Institute (P30CA008748)
- National Institute of General Medical Sciences (T32GM007739)
- National Institute of Allergy and Infectious Diseases (1R01 AI42135, 1K23AI095398-01, K23-AI095398, R01AI042135)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Health Sciences › Medicine › Hematology › Hematopoietic Stem Cell Transplantation
- Keywords
- bacteremia, allogeneic hematopoietic stem cell transplantation, gut microbiota, microbial diversity, Enterococcus, vancomycin-resistant enterococci, Proteobacteria, metronidazole, fluoroquinolones, fecal microbiota
- MeSH terms
- Adult, Aged, DNA, Bacterial, DNA, Ribosomal, Feces, Female, Humans, Longitudinal Studies, Male, Middle Aged, Phylogeny, Risk Factors, RNA, Ribosomal, 16S, Bacteremia, Sequence Analysis, DNA, Hematopoietic Stem Cell Transplantation, Biodiversity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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