Clostridium difficile infection in Chilean patients submitted to hematopoietic stem cell transplantation

Abstract

IntroductionPatients submitted to hematopoietic stem cell transplantation have an increased risk of Clostridium difficile infection and multiple risk factors have been identified. Published reports have indicated an incidence from 9% to 30% of transplant patients however to date there is no information about infection in these patients in Chile.MethodsA retrospective analysis was performed of patients who developed C. difficile infection after hematopoietic stem cell transplantations from 2000 to 2013. Statistical analysis used the Statistical Package for the Social Sciences software.ResultsTwo hundred and fifty patients were studied (mean age: 39 years; range: 17–69), with 147 (59%) receiving allogeneic transplants and 103 (41%) receiving autologous transplants. One hundred and ninety-two (77%) patients had diarrhea, with 25 (10%) cases of C. difficile infection being confirmed. Twenty infected patients had undergone allogeneic transplants, of which ten had acute lymphoblastic leukemia, three had acute myeloid leukemia and seven had other diseases (myelodysplastic syndrome, chronic myeloid leukemia, severe aplastic anemia). In the autologous transplant group, five patients had C. difficile infection; two had multiple myeloma, one had amyloidosis, one had acute myeloid leukemia and one had germinal carcinoma. The overall incidence of C. difficile infection was 4% within the first week, 6.4% in the first month and 10% in one year, with no difference in overall survival between infected and non-infected groups (72.0% vs. 67.6%, respectively; p-value = 0.56). Patients infected after allogeneic transplants had a slower time to neutrophil engraftment compared to non-infected patients (17.5 vs. 14.9 days, respectively; p-value = 0.008). In the autologous transplant group there was no significant difference in the neutrophil engraftment time between infected and non-infected patients (12.5 days vs. 11.8 days, respectively; p-value = 0.71). In the allogeneic transplant group, the median time to acute graft-versus-host disease was similar between the two groups (p-value = 0.08), as was the incidence of grades 1–4 acute graft-versus-host disease (40% vs. 48%; p-value >0.05).ConclusionThe incidence of C. difficile infection after hematopoietic stem cell transplantation was low, with a significant number of cases occurring shortly after transplantation. Allogeneic transplants had a three-time higher risk of infection compared to autologous transplants, but this was not associated with increased mortality, decreased overall survival or higher risk of acute graft-versus-host disease.

A Single-Center Experience and Literature Review of Management Strategies for Clostridium difficile Infection in Hematopoietic Stem Cell Transplant Patients

“…Our single-center study showed a higher incidence of CDI 20% (11 cases) among allo-HSCT recipients as compared to 4.8% in auto-HSCT recipients (6 cases), a finding which is similar to the reported literature. (9,33), (13,24,34,35) Our analysis did not find any statistically significant association of factors such as patients' age, gender, cancer type, allogeneic donor source, and transplant type with the development of CDI. However, small patient population size is a limitation of our study.…”

“…These findings are in contrast with a few previous studies. (24,33) This difference could be due to the prompt diagnosis and treatment of patients with CDI at our hospital. Our analysis found the longer LOS and greater than four lines of antibiotics used prior to and during HSCT was significantly higher in patients with CDI compared to those without CDI.…”

Diarrea nosocomial por Clostridiodes difficile en un hospital de referencia en Lima, Perú

“…El deterioro de la inmunidad por el envejecimiento, junto a las comorbilidades confiere mayor susceptibilidad a la ICD [6,27] . Si existe alguna condición especial el riesgo es mayor, como el observado en tres pacientes con DACD que tuvieron diagnóstico de leucemia aguda, por lo que la inmunosupresión asociada al trasplante de médula ósea y los regímenes de acondicionamiento que ocasionan mucositis pueden favorecer el desarrollo de DACD [28] . En el servicio de hematología, la aparición de diarrea probablemente se relaciona con el efecto de altas dosis de quimioterapia en la mucosa gastrointestinal y el efecto de antibióticos de amplio espectro para la profilaxis y tratamiento de neutropenia [29] .…”

Prevalence of Clostridium difficile Infection in the Hematopoietic Transplantation Setting: Update of Systematic Review and Meta-Analysis

“…Given a set of important factors, such as the transplant population, follow-up period, and testing method, the incidence of confirmed CDI among autologous HSCT (auto-HSCT) recipients varies from 5% to 24% ( Bruminhent et al., 2014 ; Pilcante et al., 2015 ), whereas the incidence among allogeneic HSCT (allo-HSCT) recipients varies from 9% to 34% ( Lavallee et al., 2017 ; Dubberke et al., 2017 ). An earlier systematic review of published literature until 2014 showed that the pooled prevalence of CDI among 12,025 HSCT patients was 7.9%, and an increasing trend of CDI diagnosis was also found worldwide and across studies conducted in North America over the last 34 years ( Zacharioudakis et al., 2014 ).…”