Predictors of mortality attributable to Clostridium difficile infection in patients with underlying malignancy

Yoon, Young Kyung; Kim, Hye Suk; Choi, Yoon Ji; Kim, Jung Sun; Kim, Seung Tae; Park, Kyong Hwa; Kim, Seok Jin; Kim, Byung Soo; Shin, Sang Won; Kim, Yeul Hong; Park, Yong

doi:10.1007/s00520-014-2174-7

Cited by 28 publications

(16 citation statements)

References 36 publications

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“…This is greater than the 9.1–16.3% mortality reported by others, perhaps due to differences in duration of neutropenia or dissimilarities in study populations [25, 26]. Neutropenia was found to independently predict CDI-related mortality in these patients [24]. …”

Section: Discussionmentioning

confidence: 89%

“…This increase in stay was largely attributed to cancer-related care, as the cancer patients often required neutropenia management, total parenteral nutrition, or pain control [23]. In a study of 5594 adult patients receiving cancer treatment with CDI, CDI-related mortality was 19.7% [24]. This is greater than the 9.1–16.3% mortality reported by others, perhaps due to differences in duration of neutropenia or dissimilarities in study populations [25, 26].…”

Section: Discussionmentioning

confidence: 99%

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Poorer outcomes among cancer patients diagnosed with Clostridium difficile infections in United States community hospitals

et al. 2017

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BackgroundCancer predisposes patients to Clostridium difficile infection (CDI) due to health care exposures and medications that disrupt the gut microbiota or reduce immune response. Despite this association, the national rate of CDI among cancer patients is unknown. Furthermore, it is unclear how CDI affects clinical outcomes in cancer. The objective of this study was to describe CDI incidence and health outcomes nationally among cancer patients in the United States (U.S.).MethodsData for this study were obtained from the U.S. National Hospital Discharge Surveys from 2001 to 2010. Eligible patients included those at least 18 years old with a discharge diagnosis of cancer (ICD-9-CM codes 140–165.X, 170–176.X, 179–189.X, 190–209.XX). CDI was identified using ICD-9-CM code 008.45. Data weights were applied to sampled patients to provide national estimates. CDI incidence was calculated as CDI discharges per 1000 total cancer discharges. The in-hospital mortality rate and hospital length of stay (LOS) were compared between cancer patients with and without CDI using bivariable analyses.ResultsA total of 30,244,426 cancer discharges were included for analysis. The overall incidence of CDI was 8.6 per 1000 cancer discharges. CDI incidence increased over the study period, peaking in 2008 (17.2 per 1000 cancer discharges). Compared to patients without CDI, patients with CDI had significantly higher mortality (9.4% vs. 7.5%, p < 0.0001) and longer median LOS (9 days vs. 4 days, p < 0.0001).ConclusionsCDI incidence is increasing nationally among cancer patients admitted to U.S. community hospitals. CDI was associated with significantly increased mortality and hospital LOS.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Poorer outcomes among cancer patients diagnosed with Clostridium difficile infections in United States community hospitals

et al. 2017

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“…Complete depletion of neutrophils with anti-GR1 antibody increases CDI-associated mortality; however, inhibition of neutrophil recruitment through blockage of CD18 or macrophage inflammatory protein (MIP) 2, or inhibition of IL-23 reduces tissue pathology and mortality during infection [31,37,38,53,54]. Similarly, in human patients, high neutrophil counts are associated with more severe disease, whereas neutropenia is a risk factor during infection [55,56]. Thus, type-17-associated immunity is essential for pathogen elimination; however, if left unregulated, it can contribute to profound tissue damage during infection.…”

Section: The Microbiota Maintains Protective Type 2 Polarizing Cytokimentioning

confidence: 99%

Considering the Immune System during Fecal Microbiota Transplantation for Clostridioides difficile Infection

Frisbee

Petri

2020

Trends in Molecular Medicine

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Our understanding and utilization of fecal microbiota transplantation (FMT) has jump-started over the past two decades. Recent technological advancements in sequencing and metabolomics have allowed for better characterization of our intestinal microbial counterparts, triggering a surge of excitement in the fields of mucosal immunology and microbiology. This excitement is well founded, as demonstrated by 90% relapse-free cure rates in FMT treatment for recurrent Clostridioides difficile infections. Growing evidence suggests that in addition to bacterial factors, the host immune response during C. difficile infection greatly influences disease severity. In this review, we discuss recent advancements in understanding the interplay between immune cells and the microbiota and how they may relate to recovery from C. difficile through FMT therapy.

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“…Increased incidence of C. difficile has been associated to leukemia patients with neutropenia [53], also in a study with allogenic hematopoietic stem cell transplant patients, individuals with neutropenia were more likely to have C. difficile infection recurrence compared to non-neutropenic individuals [12]. As neutropenia appears to be a risk factor for developing C. difficile infection as well as a marker of disease severity in patients receiving chemotherapy [13,54], a recent case control study of 144 patients receiving chemotherapy for hematologic malignancies with C. difficile diarrhea compared to controls with C. difficile negative diarrhea, presence of neutropenia was not associated with higher mortality [13]. Similar findings have been previously reported in a prior study also comparing patients with hematological malignancies receiving chemotherapy who developed C. difficile diarrhea, compared to immunocompetent individuals without malignancy.…”

Section: Leukocytes and Scoring Systemsmentioning

confidence: 99%

Role of the leukocyte response in normal and immunocompromised host after Clostridium difficile infection

2017

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Clostridium difficile is the leading cause of healthcare-associated infections in the United States. Clinically, C. difficile-associated disease can present as asymptomatic colonization, self-limited diarrheal illness or severe colitis (that may result in death). This variability in disease course and outcomes suggests that host factors play an important role as key determinants of disease severity. Currently, there are several scoring indices to estimate severity of C. difficile-associated disease. Leukocytosis and renal failure are considered to be the most important predictors of C. difficile disease severity in hosts with a normal immune system. The degree of leukocytosis which is considered significant for severe disease and how it is scored vary amongst scoring indices. None of the scores have been prospectively validated, and while total WBC count is useful to estimate the magnitude of the host response in most patient populations, in immune-compromised patients like those receiving chemotherapy, solid organ transplant patients or hematopoietic stem cell transplants the WBC response can be variable or even absent making this marker of severity difficult to interpret. Other cellular subsets like neutrophils, eosinophils and lymphocytes provide important information about the host immune status and play an important role in the immune response against C. difficile infection. However, under the current scoring systems the role of these cellular subsets have been underestimated and only total white blood cell counts are taken into account. In this review we highlight the role of host leukocyte response to C. difficile challenge in the normal and immunocompromised host, and propose possible ways that would allow for a better representation of the different immune cell subsets (neutrophils, lymphocytes and eosinophils) in the current scoring indices.

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Predictors of mortality attributable to Clostridium difficile infection in patients with underlying malignancy

Cited by 28 publications

References 36 publications

Poorer outcomes among cancer patients diagnosed with Clostridium difficile infections in United States community hospitals

Poorer outcomes among cancer patients diagnosed with Clostridium difficile infections in United States community hospitals

Considering the Immune System during Fecal Microbiota Transplantation for Clostridioides difficile Infection

Role of the leukocyte response in normal and immunocompromised host after Clostridium difficile infection

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