Late poor outcomes of Clostridioides difficile infections in oncological patients: A multicentre cohort study

Abstract

Background Cancer has been associated with an increased risk of in-hospital mortality in CDI patients. However, data on delayed mortality in cancer patients with CDI are scarce. Aim/Objective The aim of the present study was to compare outcomes between oncological patients and the general population with Clostridioides difficile infection (CDI) after 90 days of follow-up. Methods A multicenter prospective cohort study was conducted in 28 hospitals participating in the VINCat program. Cases were all consecutive adult patients who met the case definition of CDI. Sociodemographic, clinical, and epidemiological variables and evolution at discharge and after 90 days were recorded for each case. Findings/results The mortality rate was higher in oncological patients (OR = 1.70, 95% CI: 1.08–2.67). In addition, oncological patients receiving chemotherapy (CT) presented higher recurrence rates (18.5% vs 9.8%, p = 0.049). Among oncological patients treated with metronidazole, those with active CT showed a higher rate of recurrence (35.3% vs 8.0% p = 0.04). Discussion Oncological patients presented a higher risk of poor outcomes after CDI. Their early and late mortality rates were higher than in the general population, and in parallel, those undergoing chemotherapy (especially those receiving metronidazole) had higher rates of recurrence

Clostridioides difficile recurrence in individuals with and without cancer: a Swedish population-based cohort study

“…Our apparent less frequent recurrence compared to individuals without cancer may seem contra-intuitive and contrary to some previous studies which have suggested increased recurrence [ 50 – 52 ]. Yet, previous meta-analyzes did not find strong evidence for an association [ 14 – 16 ], and other studies show similar results [ 12 , 53 ]. The inclusion of community-acquired CDI in our study probably made little difference, as 97% of those with ongoing cancer was deemed health-care acquired compared to 90% of those without cancer.…”

Clostridioides difficile Infection: Targeting an Unwelcome and Persistent Threat

“…51 Calbo investigated CDI in patients with cancer, and found a higher risk of CDI recurrence (13%) and mortality (27%), particularly late mortality (3 months after initial episode: 13%). 52 Calbo concluded that in select populations (the elderly, patients with cancer, and patients with recurrent CDI), delayed mortality rates may be higher than early mortality rates. For the initial CDI, 63.5% of the audience selected fidaxomicin (200 mg twice daily [BID] for 10 days) as the best therapy for this patient, while 30.4% selected vancomycin (125 mg QID for 10 days), and 6.1% chose metronidazole (500 mg three times daily for 10 days).…”