Clostridium difficile-associated diarrhoea, a frequent complication in patients with acute myeloid leukaemia

Schalk, Enrico; Bohr, Ulrich R. M.; König, Brigitte; Scheinpflug, Katrin; Mohren, Martin

doi:10.1007/s00277-009-0772-0

Cited by 61 publications

(66 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Risk factors for C. difficile infections among oncology patients include chemotherapeutic agents; antibiotics, especially cephalosporins and clindamycin; frequent hospitalizations; and prolonged neutropenia (256)(257)(258). While it might be anticipated that cancer patients receiving chemotherapy will have a severe course and increased risk of death compared to other hospitalized patients, in at least one study, this was not the case (259).…”

Section: Oncology Patients (Nontransplant)mentioning

confidence: 82%

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

2013

View full text Add to dashboard Cite

SUMMARY Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile . This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.

show abstract

Section: Oncology Patients (Nontransplant)mentioning

confidence: 82%

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

2013

View full text Add to dashboard Cite

show abstract

“…Diarrhea is a common complication in patients who receive high doses of chemotherapy and in those undergone hematopoietic stem cell transplant (HSCT) 3,13,21,23 . Clostridium difficile has frequently been identified as cause of infectious diarrhea in hospital setting.…”

Section: Introductionmentioning

confidence: 99%

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

Spadão

Gerhardt

Guimarães

et al. 2014

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematologic and patients undergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011, using two denominators 1,000 patient and 1,000 days of neutropenia and the risk factors associated with the severe form of the disease and death. The ELISA method (Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identify C. difficile. A multivariate analysis was performed to evaluate potential factors associated with severe CDAD and death within 14 days after the diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were identified in 64 patients among 439 patients with diarrhea during the study period. CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from 0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute myeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (45%) undergone allogeneic HSCT, 61/64 (88%) had previously used antibiotics and 9/64 (13%) have severe CDAD. Most of the patients (89%) received treatment with oral metronidazole and 19/64 (26%) died. The independent risk factors associated with death were the severe form of CDAD, and use of linezolid.

show abstract

“…A review of the literature reveals that diarrhea and neutropenic enterocolitis are the two major clinical complications in this field. [4][5][6][7][8][9][10][11] Where specified, definitions of diarrhea vary only slightly across trials, usually requiring at least three or four unformed stools within 24 h. [4][5][6][7][8][9][10][11][12] Clostridium difficile (C. difficile) has frequently been identified as the causative pathogen, with reported incidence rates ranging from 4.8-9% in patients with acute myelogenous leukemia, from 4.9-7.5% in patients undergoing autologous stem cell transplantation and from [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].4% in those undergoing allogeneic stem cell transplantation. 5,6,9,11,13,14 Other associated factors include prior use of antibiotics or certain antineoplastic agents, e.g.…”

Section: Introductionmentioning

confidence: 99%

Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients

Vehreschild

Meißner²,

Cornely³

et al. 2011

Haematologica

View full text Add to dashboard Cite

BackgroundNeutropenic patients are at risk of abdominal complications and yet the incidence and impact of these complications on patients' morbidity and mortality have not been sufficiently evaluated. We aimed to assess a clinical rule for early detection of abdominal complications leading to death or transfer to intensive care in patients with chemotherapy-associated neutropenia. Design and MethodsThis observational multicenter study was carried out in seven German hematology-oncology departments. For inclusion, neutropenia of at least 5 consecutive days was required. Risk factors for "transfer to intensive care" and "death" were assessed by backward-stepwise binary logistic regression analyses. Chemotherapy-associated bowel syndrome was defined as a combination of fever (T ≥37.8 °C) and abdominal pain and/or lack of bowel movement for 72 hours or more. Five hundred and twenty-one neutropenic episodes were documented in 359 patients. ResultsThe incidence of chemotherapy-associated bowel syndrome was 126/359 (35%) in first episodes of neutropenia. Transfer to intensive care occurred in 41/359 (11%) and death occurred in 17/359 (5%) first episodes. Chemotherapy-associated bowel syndrome and duration of neutropenia were identified as risk factors for transfer to intensive care (P<0.001; OR 4.753; 95% CI 2.297-9.833, and P=0.003; OR 1.061/d; 95% CI 1.021-1.103). Chemotherapyassociated bowel syndrome and mitoxantrone administration were identified as risk factors for death (P=0.005; OR 4.611; 95% CI 1.573-13.515 and P=0.026; OR 3.628; 95% CI 1.169-11.256). ConclusionsThe occurrence of chemotherapy-associated bowel syndrome has a significant impact on patients' outcome. In future interventional clinical trials, this definition might be used as a selection criterion for early treatment of patients at risk of severe complications.Key words: neutropenia, chemotherapy-associated bowel syndrome, risk prediction.Citation: Vehreschild MJGT, Meißner AMK, Cornely OA, Maschmeyer G, Neumann S, von Lilienfeld-Toal M, Karthaus M, Wattad M, Staib P, Hellmich M, Christ H, and Vehreschild J-J. Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients.

show abstract

Clostridium difficile-associated diarrhoea, a frequent complication in patients with acute myeloid leukaemia

Cited by 61 publications

References 33 publications

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

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

Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients

Contact Info

Product

Resources

About