Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm?

Bobak, David A.; Arfons, Lisa; Creger, Richard J.; Lazarus, Hillard M.

doi:10.1038/bmt.2008.317

Cited by 57 publications

(51 citation statements)

References 44 publications

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“…Diarrhoea is common in almost 90 % of HSCT recipients for multiple reasons, including GVHD (Bobak et al, 2008). A bidirectional relationship between CDI and GVHD has been highlighted in a number of recent studies (Murphy & Nguyen, 2011;Alonso & Marr, 2013).…”

Section: Discussionmentioning

confidence: 99%

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Risk factors, outcomes and epidemiology associated with Clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in China

Chen

et al. 2015

Journal of Medical Microbiology

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The purpose of this study was to evaluate the risk factors, outcomes and epidemiology associated with Clostridium difficile infection (CDI) in patients with haematological malignancies in a tertiary care hospital in China. C. difficile screening was performed on patients admitted for chemotherapy or haematopoietic stem cell transplantation between 2009 and 2013. C. difficile isolates were analysed by multilocus sequence typing, and a retrospective chart review was performed on all patients with a positive toxin assay. CDI was diagnosed in 21 haematologyoncology ward patients and 14 marrow transplantation service patients for a cumulative incidence of 1.89/1000 and 3.69/1000 patient-days, respectively. Univariate analyses showed that patients who received etoposide had an increased risk of CDI (odds ratio 4.25, 95 % confidence interval 1.32-13.64). There was only one patient death, for which CDI was not the primary cause. Ten sequence types (STs) were identified, of which ST-3 and ST-54 were the most common; the hypervirulent ST-1 (ribotype 027) and ST-11 (ribotype 078) C. difficile strains were not detected in the patients in this study. The incidence of CDI did not differ between patients receiving chemotherapy and those receiving haematopoietic stem cell transplantation. The only risk factor for chemotherapy patients was treatment with etoposide.

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Section: Discussionmentioning

confidence: 99%

“…Reports show a 76-91 % incidence of diarrhoea in HSCT recipients (Tomblyn et al, 2002), and the incidence of CDI in these patients can be as high as 20 % (Bobak et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Risk factors, outcomes and epidemiology associated with Clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in China

Chen

et al. 2015

Journal of Medical Microbiology

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Section: Hematopoietic Stem Cell Transplant Patientsmentioning

confidence: 99%

“…A recent review reports the incidence of C. difficile disease among HSCT patients to be as high as 20% (263). In most studies, there do not appear to be any unique risk factors among HSCT recipients that are not shared by other nontransplant at-risk patients (256,263). However, in a large study by Dubberke et al, patients who received a third-or fourth-generation cephalosporin were more at risk for development of C. difficile disease (264).…”

Section: Hematopoietic Stem Cell Transplant Patientsmentioning

confidence: 99%

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

2013

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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.

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“…Clostridium difficile-associated diarrhea (CDAD), and the response to conventional anti-CDAD therapy with oral vancomycin or metronidazole remains suboptimal (1)(2)(3)(4)(5)(6). Fidaxomicin, a macrocyclic antibiotic with a limited spectrum of antimicrobial activity, became available in the United States in May 2011 (6)(7)(8)(9).…”

Section: P Atients Undergoing Transplantation Have An Increased Risk Formentioning

confidence: 99%

Fidaxomicin versus Conventional Antimicrobial Therapy in 59 Recipients of Solid Organ and Hematopoietic Stem Cell Transplantation with Clostridium difficile-Associated Diarrhea

Clutter

Dubrovskaya

Merl

et al. 2013

Antimicrob Agents Chemother

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The feasibility of fidaxomicin versus vancomycin and metronidazole (conventional therapy) was assessed in 59 transplant recipients with 61 episodes of Clostridium difficile-associated diarrhea (CDAD). Overall clinical cure was achieved in 86% of episodes, and in 7% of episodes, infection recurred. Fidaxomicin was well tolerated. Clinical cures were not significantly different compared with conventional therapy (67% versus 89%, respectively; P ‫؍‬ 0.06). Univariate analysis of predictors for lack of clinical cure included continued use of broad-spectrum systemic antibiotics (P ‫؍‬ 0.026) and prior diagnosis of CDAD (95% confidence interval, 1.113 to 19.569; odds ratio, 4.667; P ‫؍‬ 0.041). New-onset vancomycin-resistant Enterococcus (VRE) colonization was not noted after fidaxomicin therapy alone. However, this occurred in 10 of 28 patients (36%) following conventional therapy, and 2 of 3 patients with subsequent bacteremia died.

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Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm?

Cited by 57 publications

References 44 publications

Risk factors, outcomes and epidemiology associated with Clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in China

Risk factors, outcomes and epidemiology associated with Clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in China

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

Fidaxomicin versus Conventional Antimicrobial Therapy in 59 Recipients of Solid Organ and Hematopoietic Stem Cell Transplantation with Clostridium difficile-Associated Diarrhea

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