Clostridium difficile. Colonization and toxin production in a cohort of patients with malignant hematologic disorders

Morris, J. Glenn; Jarvis, William R.; Nunez-Montiel, O; Towns, Michael; Thompson, F; Dowell, V. R.; Hill, E. O.; Wr, Vogler; Winton, EF; Hughes, James M.

doi:10.1001/archinte.144.5.967

Cited by 19 publications

(14 citation statements)

References 13 publications

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“…J. Cancer (I 992), 66, 666 667 Discussion The contribution of Clostridium difficile as a cause of diarrhoea in patients with malignant diseases as reported by others (Cudmore et al, 1982;Morris et al, 1984;Miller & Koornhof, 1984;Rampling et al, 1985;Heard et al, 1988) was confirmed by the present study. However, most reports have dealt with description of single patients (Cudmore et al, 1982;Miller & Koornhof, 1984;Rampling et al, 1985;Fainstein et al, 1981), and only few studies have produced estimation of the incidence/prevalence of this infection in a prospectively manner (Morris et al, 1984;Heard et al, 1988).…”

Section: Methodssupporting

confidence: 84%

“…However, most reports have dealt with description of single patients (Cudmore et al, 1982;Miller & Koornhof, 1984;Rampling et al, 1985;Fainstein et al, 1981), and only few studies have produced estimation of the incidence/prevalence of this infection in a prospectively manner (Morris et al, 1984;Heard et al, 1988). Acute leukaemias were identified as increasing the risk of infection (Morris et al, 1984;Heard et al, 1988), whereas no data are available for patients with solid tumours.…”

Section: Methodsmentioning

confidence: 99%

“…Several reports document that diarrhoea in such patients may be associated with Clostridium difficile (Cudmore et al, 1982;Morris et al, 1984;Miller & Koornhof, 1984;Rampling et al, 1985;Heard et al, 1988). The factors leadings to C. dificile infection in an individual patient are many, involving the frequent administration of antibacterial chemotherapy in such patients (Bartlett, 1979), gastrointestinal toxicity of antineoplastic chemotherapy (Miller & Koornhof, 1984;Fainstein et al, 1981), and possibly environmental exposure to the microorganism (Heard et al, 1988;Kim et al, 1981).…”

mentioning

confidence: 99%

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High prevalence of Clostridium difficile diarrhoea during intensive chemotherapy for disseminated germ cell cancer

Nielsen

Daugaard²,

Tvede³

et al. 1992

Br J Cancer

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A prospective, consecutive study of the aetiology of treatment-associated diarrhoea was conducted in 25 patients with disseminated germ cell cancer treated with intensive chemotherapy. Clostridium difficile was isolated in 45% of the diarrhoea episodes, which makes this species the most important bacterial pathogen in the development of clinically significant diarrhoea in this group of immunocompromised patients.

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Section: Methodssupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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High prevalence of Clostridium difficile diarrhoea during intensive chemotherapy for disseminated germ cell cancer

Nielsen

Daugaard²,

Tvede³

et al. 1992

Br J Cancer

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“…C. difficile was identified by Hall and O'Toole abdominal pain (80-90%) [5,21,22,[51][52][53][54][55][56]. The severity of diarrhea may vary from mild diarrhea that resolves as [24] in 1935.…”

Section: Historical Background and General Aspectsmentioning

confidence: 99%

<i>Clostridium difficile </i>Infection: Risk Factors, Medical and Surgical Management

Klingler¹,

Metzger²,

Seelig³

et al. 2000

Dig Dis

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Background:Clostridium difficile has become recognized as a cause of nosocomial infection which may progress to a fulminant disease. Methods: Literature review using electronic literature research back to 1966 utilizing Medline and Current Contents. All publications on antibiotic-associated diarrhea, antibiotic-associated colitis, and pseudomembranous colitis as well as C. difficile infection were included. We addressed established and potential risk factors for C. difficile disease such as an impaired immune system and cost benefits of different diagnostic tests. An algorithm is outlined for diagnosis and both medical and surgical management of mild, moderate and severe C. difficile disease. Results: Diagnosis of C. difficile infection should be suspected in patients with diarrhea, who have received antibiotics within 2 months or whose symptoms started after hospitalization. A stool specimen should be tested for the presence of leukocytes and C. difficile toxins. If this is negative and symptoms persist, stool should be tested with ‘rapid’ enzyme immunoabsorbent and stool cytotoxin assays, which are the most cost-effective tests. Endoscopy and other imaging studies are reserved for severe and rapidly progressive courses. Oral metronidazole or vancomycin are the antibiotics of choice. Surgery is rarely required for selected patients refractory to medical treatment. The threshold for surgery in severe cases with risk factors including an impaired immune system should be low. Conclusion:C. difficile infection has been recognized with increased frequency as a nosocomial infection. Early diagnosis with immunoassays of the stool and prompt medical therapy have a high cure rate. Metronidazole has supplanted oral vancomycin as the drug of first choice for treating C. difficile infections.

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“…Although we do not have similar comparisons with regards to rates per antibiotic usage, the high identification of C difficile in our NAD and CAD populations may reflect a high baseline rate of antibiotic usage, good detection techniques for C difficile or differences in our population in terms of food preparation and consumption. Similarly, patients with malignant disease receiving chemotherapy have been noted to be at risk for C difficile infection because of the numerous courses of antibiotics that they receive and because cancer chemotherapy itself may predispose patients to gut colonization with C difficile (53)(54)(55)(56). CAD episodes in which bacterial pathogens were isolated were predominantly in children older than five years of age.…”

Section: Discussionmentioning

confidence: 99%

Differential Yield of Pathogens from Stool Testing of Nosocomial versus Community‐Acquired Paediatric Diarrhea

Deorari

McConnell

Tan

et al. 1999

Canadian Journal of Infectious Diseases and Medical Microbiolog

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OBJECTIVES:To evaluate the role of routine stool examination for all pathogens in paediatric nosocomial diarrhea (NAD) and community-acquired diarrhea (CAD) over a two-year period at Alberta Children's Hospital and current practices in other Canadian hospitals. A secondary objective was to characterize features that may predict NAD or CAD etiology. STUDY DESIGN: Retrospective cohort study and telephone survey. SETTING: Alberta Children's Hospital (retrospective review) and Canadian tertiary care paediatric centres (telephone survey). METHODS:The health and microbiological records of all children with an admission or discharge diagnosis of diarrhea were reviewed using a standardized data collection form. In addition, a telephone survey of laboratories serving all paediatric hospitals in Canada was conducted using a standard questionnaire to obtain information about practices for screening for pathogens related to NAD. RESULTS: Four hundred and thirty-four CAD episodes and 89 NAD episodes were identified. Overall, rotavirus and Clostridium difficile were the most commonly identified pathogens. Bacterial culture was positive in 10.6% CAD episodes tested, with Escherichia coli O157:H7 identified as the most common non-C difficile organism. In NAD, no bacteria were identified other than C difficile (toxin). Screening for ova and parasites had negligible yield. Viruses were more frequent in the winter months, while bacterial pathogens were more common in the summer and fall months. Over 50% of Canadian paediatric hospitals still routinely process NAD specimens similarly to CAD specimens. CONCLUSIONS: There is a need for the re-evaluation of routine ova and parasite screening, and bacterial culture in nonoutbreak episodes of NAD in children.

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Clostridium difficile. Colonization and toxin production in a cohort of patients with malignant hematologic disorders

Cited by 19 publications

References 13 publications

High prevalence of Clostridium difficile diarrhoea during intensive chemotherapy for disseminated germ cell cancer

High prevalence of Clostridium difficile diarrhoea during intensive chemotherapy for disseminated germ cell cancer

<i>Clostridium difficile </i>Infection: Risk Factors, Medical and Surgical Management

Differential Yield of Pathogens from Stool Testing of Nosocomial versus Community‐Acquired Paediatric Diarrhea

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