Impact of Clostridioides difficile infection on the outcome of patients receiving a hematopoietic stem cell transplantation

Abstract

Objectives: Clostridioides difficile infections (CDI) are common in autologous (auto-HSCT) or allogenic hematopoietic stem cell transplant (allo-HSCT) recipients. However, the impact of CDI on patient outcomes is controversial. We conducted this study to examine the impact of CDI on patient outcomes. Methods: We performed a retrospective single-center study, including 191 lymphoma patients receiving an auto-HSCT and 276 acute myeloid leukemia (AML) patients receiving an allo-HSCT. The primary endpoint was overall survival (OS). Secondary endpoints were causes of death and, for the allo-HSCT cohort, GvHD-and relapse-free survival (GRFS). Results: The prevalence of CDI was 17.6% in the AML allo-HSCT and 7.3% in the lymphoma auto-HSCT cohort. A higher prevalence of bloodstream infections, but no differences concerning OS or cause of death were found for patients with CDI in the auto-HSCT cohort. [AU] In the allo-HSCT cohort, OS and GRFS were similar between CDI and non-CDI patients. However, the leading cause of death was relapse among non-CDI patients, but it was infectious diseases in the CDI group with fewer deaths due to relapse. Conclusions: CDI was not associated with worse survival in patients receiving a hematopoietic stem cell transplantation, and there were even fewer relapse-related deaths in the AML allo-HSCT cohort.

Low Rate of Infectious Enterocolitis in Allogeneic Stem Cell Transplant Recipients with Acute Diarrhea: A Prospective Study by the GETH-TC

“…Of note, all 10 patients were receiving empirical broad-spectrum antibiotic treatment, and none developed severe CDI. Compared with previous reports [9], both the CDI incidence (13%) and recurrence (2%) were low.…”

Prevention and treatment of C. difficile in cancer patients

“…Most studies involving cancer patients have reported low rates of severe or fatal cases of CDI [12,29 ▪▪ ,41,42]. For instance, a recent study in patients with acute myeloid leukaemia (AML) found no differences in various clinical parameters, such as length of stay, need for ICU admission, development of acute renal failure, chemotherapy response, or mortality, between patients with or without CDI [11 ▪ ].…”

“…Different studies, using nonhomogenous definitions, have reported CDI incidence and infection rates ranging from 6% to 33% in cancer patients [6,8–10,11 ▪ ,12], with higher rates in those with haematological malignancies compared to those with solid tumours [13]. Specifically in hematopoietic stem cell transplant (HSCT) recipients, CDI incidences have ranged from 8% to 31% depending on the source and type of transplant, with umbilical cord and allogeneic HSCT showing the highest incidences [8,14–17].…”

Clostridioides difficile infection in the allogeneic hematopoietic cell transplant recipient

“…Weber et al 27 performed a retrospective study evaluating the impact of CDI on HCT recipients. They included 276 patients receiving allo-HCT and 191 patients receiving auto-HCT.…”