Prognosis of Clostridium difficile infection in adult oncohaematological patients: experience from a large prospective observational study

Abstract

The aim of the study is to evaluate demographics, epidemiology, clinical characteristics, treatment and outcomes of Clostridium difficile infection (CDI) in patients with and without concurrent cancer. This is a prospective cohort study of consecutive primary CDI episodes in adults (January 2006-December 2016). CDI was diagnosed on the presence of diarrhoea and positive stool testing for toxigenic C. difficile. Univariate analysis assessed differences between cancer and non-cancer patients. Risk factors of all-cause 30-day mortality were determinate using the logistic multivariable procedure. In total, 787 CDI episodes were recorded, 191 in cancer patients (median age 64, IQR 50-73). Of these, 120 (63%) had solid and 71 (37%) haematological malignancies (24 received a stem cell transplant). At the CDI diagnosis, 158 (82.7%) cancer patients had prior antibiotics and 150 (78.5%) were receiving proton pump inhibitors. Fifty-seven (80.3%) patients with haematological and 52 (43.3%) with solid malignancies were under chemotherapy at diagnosis; 25 (35.2%) with haematological and 11 (9.2%) with solid malignancies had an absolute neutrophil count < 1000/mm. Overall, 30-day mortality was higher in cancer patients than in those without (19.2 vs. 8.6% respectively, p < 0.001); recurrence rates did not vary significantly (11.1 vs. 11%, p = 0.936). By type of neoplasm, 30-day mortality was higher in patients with haematological malignancies and solid tumours than in patients without cancer (respectively, 25.4 vs. 8.6%; p < 0.001 and 15 vs. 8.6%; p < 0.001). Our results suggest that the prognosis of CDI (30-day mortality) is poorer in patients with cancer than in those without although percentages of recurrent infection are similar in these two patient populations.

Outcomes ofClostridioides difficileinfection in adult cancer and non-cancer patients hospitalised in a tertiary hospital: a prospective cohort study

“…Advanced age is recognised as a risk factor for CDI in cancer and non-cancer patients 24. The age differed among our cohort, with patients with haematological malignancies being younger while non-cancer patients were older than patients with solid tumours, which is in line with some other studies 12 18 25 26…”

“…In our cohort, cancer patients were more exposed to antibiotic use than non-cancer patients, but the exposure was very high (>90%) in both groups. In contrast, the study by Larrainzar-Coghen et al showed similar exposure to antibiotics prior to CDI between cancer and non-cancer patients (82.7% and 86.7%, respectively) 18. The most frequently used antibiotics in our study were fluoroquinolones and cephalosporins of the second and third generation, but there was no difference in exposure between cancer and non-cancer patients.…”

“…The use of PPIs was higher in patients with haematological malignancy than in patients with solid tumours, but overall there was no significant difference between cancer and non-cancer patients. Similar findings were reported by Larrainzar-Coghen et al 18. A meta-analysis which included a large number of observational studies found that the risk of CDI was almost two times higher in PPI users than in non-users 32…”

“…There was no difference between cancer and non-cancer patients regarding the number of antibiotics used or the length of treatment. However, patients with haematological malignancy were treated with a larger number of antibiotics and for a longer period, in accordance with previous data 18 28. The use of combinations of antibiotics for a prolonged time has been associated with an increased risk of CDI in cancer and non-cancer patients 29–31…”

“…The characteristics of CDI in patients with cancer have been described, but there are limited data comparing treatment outcomes in cancer and non-cancer patients 10 18–20. The aim of this study was to investigate all-cause 30-day mortality associated with CDI in patients with solid and haematological malignancies versus patients with no underlying malignancy in a tertiary healthcare centre in Serbia.…”