Clostridioides difficile Infections in Inpatient Pediatric Oncology Patients: A Cohort Study Evaluating Risk Factors and Associated Outcomes

Abstract

Background Clostridioides difficile infection (CDI) is a significant source of morbidity in pediatric cancer patients. Few reports to date have evaluated risk factors and short-term outcomes for this population. Methods We retrospectively evaluated pediatric oncology admissions at St Louis Children’s Hospital from 2009 to 2018. All inpatient cases of diagnosed initial CDI were identified. We aimed to investigate the prevalence of CDI and associated risk factors, including coadmission with another patient with CDI, and to evaluate short-term outcomes including length of stay and delays in subsequent scheduled chemotherapy. Results Review of 6567 admissions from 952 patients revealed 109 CDI cases (11.4% of patients). Patients with leukemia or lymphoma, compared to those with solid tumors, were more likely to have CDI (odds ratio [OR], 3 [95% CI, 1.4–6.6], and 3 [95% CI, 1.3–6.8], respectively). Autologous hematopoietic stem cell transplant (HSCT) was also a risk factor (OR, 3.5 [95% CI, 1.7–7.4]). Prior antibiotic exposure independently increased the risk for CDI (OR, 3.0 [95% CI, 1.8–4.8]). Concurrent admission with another patient with CDI also significantly increased the risk (OR, 84.7 [95% CI, 10.5–681.8]). In contrast to previous reports, exposure to acid-suppressing medications decreased the risk for CDI (OR, 0.5 [95% CI, .3–.7]). CDI was associated with increased length of stay (mean difference, 8 days [95% CI, 4.6–11.4]) and prolonged delays for subsequent chemotherapy (mean difference, 1.4 days [95% CI, .1–2.7]). Conclusions CDI in pediatric oncology patients significantly prolongs hospitalization and delays chemotherapy treatment plans. Interventions to control CDI will improve the care of pediatric oncology patients.

Impact of dry hydrogen peroxide on hospital-acquired infection at a pediatric oncology hospital

“…6,19 While any type of HAI event can have serious consequences, the incidence of Clostridoides difficile infections (CDI) has been problematic since these events cause cancer treatment delays and prolonged length of stay. 20 During the study period, thirty-one CDI events were observed in total between the PICU and IMCU. In the PICU, incidence of CDI events reached 10.77 cases/1000 patient days in 2019, but then significantly reduced to 2.54 in 2020, after DHP was installed (p=0.048).…”

Prophylactic antibiotics for massive endoprostheses in orthopaedic oncology

“…The risk of CDI. CDI is more common in paediatric onocology patients compared to the general paediatric population 44 . Several factors may contribute to this, such as an increased exposure to antibiotics during neoadjuvant chemotherapy, for treatment or prophylaxis, an immunocompromised host, frequent hospitalization, and the use of proton pump inhibitors.…”

Clinical outcomes of antimicrobial resistance in cancer patients: A systematic review of multivariable models

“…Twelve of 144 (8%) studies studied the family Enterobacterales (especially Escherichia coli and Klebsiella pneumoniae combined), either ESBL-or carbapenemase-producing [38,[64][65][66][67][68][123][124][125][126][127][128]. The most commonly studied single organism was Clostridioides difficile with 27/144 (19%) studies [39][40][41][69][70][71][72][73][74][75][76][77][78][79][80][81][129][130][131][132][133][134][135][136][137][138][139]. Also studied were three non-fermenters with 5/144 (3%) studies about Acinetobacter baumannii [82,[140][141][142][143], 4/144 (3%) studies about Pseudomonas aeruginosa [83,84,144,…”