INCIDENCE OF DIARRHEA BY Clostridium difficile IN HEMATOLOGIC PATIENTS AND HEMATOPOIETIC STEM CELL TRANSPLANTATION PATIENTS: RISK FACTORS FOR SEVERE FORMS AND DEATH

Spadão, Fernanda; Gerhardt, Juliana; Guimarães, Thaís; Dulley, Frederico Luiz; Almeida, João Nóbrega de; Batista, Marjorie Vieira; Shikanai-Yasuda, Maria Aparecida; Levin, Anna S.; Costa, Sílvia Figueiredo

doi:10.1590/s0036-46652014000400010

Cited by 26 publications

(29 citation statements)

References 28 publications

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“…In particular, a severe form of CDI developed in 23% of allogeneic HSCT recipients, and all of them died. 88 Of note, 89% of patients in this cohort received initial treatment with metronidazole that might have influenced the clinical course of CDI.…”

Section: Clostridium Difficile Infectionmentioning

confidence: 96%

Bacterial Infections in Hematopoietic Stem Cell Transplant Recipients

Balletto¹,

Mikulska²

2015

Mediterr J Hematol Infect Dis

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Bacterial infections are major complications after Hematopoietic Stem Cell Transplant (HSCT). They consist mainly of bloodstream infections (BSI), followed by pneumonia and gastrointestinal infections, including typhlitis and Clostridium difficile infection. Microbiological data come mostly from BSI. Coagulase negative staphylococci and Enterobacteriaceae are the most frequent pathogens causing approximately 25% of BSI each, followed by enterococci, P. aeruginosa and viridans streptococci. Bacterial pneumonia is frequent after HSCT, and Gram-negatives are predominant. Clostridium difficile infection affects approximately 15% of HSCT recipients, being more frequent in case of allogeneic than autologous HSCT.The epidemiology and the prevalence of resistant strains vary significantly between transplant centres. In some regions, multi-drug resistant (MDR) Gram-negative rods are increasingly frequent. In others, vancomycin-resistant enterococci are predominant. In the era of increasing resistance to antibiotics, the efficacy of fluoroquinolone prophylaxis and standard treatment of febrile neutropenia have been questioned. Therefore, a thorough evaluation of local epidemiology is mandatory to decide the need for prophylaxis and the choice of the best regimen for empirical treatment of febrile neutropenia. For the latter, individualised approach has been proposed, consisting of either escalation or de-escalation strategy. De-escalation strategy is recommended since resistant bacteria should be covered upfront, mainly in patients with severe clinical presentation and previous infection or colonisation with a resistant pathogen.Non-pharmacological interventions, such as screening for resistant bacteria, applying isolation and contact precautions should be put in place to limit the spread of MDR bacteria. Antimicrobial stewardship program should be implemented in transplant centres.

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Section: Clostridium Difficile Infectionmentioning

confidence: 96%

Bacterial Infections in Hematopoietic Stem Cell Transplant Recipients

Balletto¹,

Mikulska²

2015

Mediterr J Hematol Infect Dis

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“…Over the past decade, CDI has increased in both frequency and severity in the USA and in other countries [ 7 – 9 ]. CDI has reportedly been widely identified in prospective laboratory surveillance and outbreaks [ 10 – 13 ]; however, there are few reports on the frequency and impact of CDI in different institutions, especially in Latin America. Accordingly, we performed the present study to determine factors associated with C. difficile infection among patients with hospital-acquired diarrhea and with poor prognosis among those with documented C. difficile colitis in a tertiary care Brazilian hospital.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and Risk Factors Associated withClostridium difficileDiarrhea in Hospitalized Adult Patients

Larentis

Rosa

Santos

et al. 2015

Gastroenterology Research and Practice

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Background. The epidemiology of Clostridium difficile infection has changed over time. Therefore, it is essential to monitor the characteristics of patients at risk of infection and factors associated with poor prognosis. Objective. To evaluate factors associated with C. difficile infection and with poor prognosis in those with documented C. difficile colitis. Methods. A retrospective case-control study of 75 patients with documented C. difficile colitis and 75 controls with hospital-acquired diarrhea of other causes. Stepwise multiple logistic regression was used to identify factors associated with C. difficile infection among patients with hospital-acquired diarrhea. Results. Previous antibiotic treatment (odds ratio (OR), 13.3; 95% confidence interval (CI), 1.40–126.90), abdominal distension (OR, 3.85; 95% CI, 1.35–10.98), and fecal leukocytes (OR, 8.79; 95% CI, 1.41–54.61) are considered as predictors of C. difficile colitis; anorexia was negatively associated with C. difficile infection (OR, 0.15; 95% CI, 0.03–0.66). Enteral tube feeding was independently associated with a composite outcome that included in-hospital mortality, intensive care unit admission, and treatment failure (OR, 3.75; 95%CI, 1.24–11.29). Conclusions. Previous antibiotic use and presence of fecal leukocytes in patients with hospital-acquired diarrhea are associated with C. difficile colitis and enteral tube support with complications associated with C. difficile colitis.

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“…Of the 550 patients who underwent HCST during the study period, 6% (35/550 patients) subsequently developed CDI. Within the literature, the incidence of CDI after all HSCT ranges from 3–17% . A higher incidence of CDI is reported among patients who underwent allogeneic HSCT .…”

Section: Discussionmentioning

confidence: 99%

“…Within the literature, the incidence of CDI after all HSCT ranges from 3-17%. 8,[19][20][21][22][23] A higher incidence of CDI is reported among patients who underwent allogeneic HSCT. 19,24,25 In our study, we also found that most patients who underwent HSCT and who developed CDI had undergone an allogeneic HSCT.…”

Section: Discussionmentioning

confidence: 99%