Risk factors associated with Clostridium difficile infection in adult oncology patients

Garzotto, Analia Rodríguez; Garcia, Antoni; Unceta, Nerea Muñoz; Lopez, Mariela; Orellana, María Ángeles; Díaz-García, C. Vanesa; Cortijo-Cascajares, Susana; Cortés, Javier; Agulló-Ortuño, M. Teresa

doi:10.1007/s00520-014-2506-7

Cited by 46 publications

(31 citation statements)

References 31 publications

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“…A study from the National Institute of Science (NIS) found an almost 5-fold higher incidence of CDI in stem cell transplant recipients and identified GVHD as a specific association with CDI. 14,25 In our study, patients with leukemia, lymphoma, and Kaposi sarcoma had the highest rates of CDI, likely related to prolonged immunosuppression and high rates of chronic antibiotic use. 26 In our study, compared with patients with cancer without CDI, those with CDI were more likely to be older, white, and from the Northeast.…”

Section: Discussionmentioning

confidence: 67%

Trends in the Incidence and Outcomes of Hospitalized Cancer Patients WithClostridium difficileInfection: A Nationwide Analysis

Gupta¹,

Tariq²,

Frank³

et al. 2017

J Natl Compr Canc Netw

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Patients with cancer have several risk factors for infection (CDI), but the impact of CDI on outcomes in this population needs elucidation. We analyzed the incidence of CDI and its impact on outcomes in patients with cancer using the National Hospital Discharge Survey (NHDS) database from 2001 to 2010. Diagnosis codes were used to identify patients with cancer and CDI events. Demographics, diagnoses, length of stay (LOS), and discharge information were abstracted. Multivariate linear and logistic regression models with weighted analysis were conducted to study CDI incidence and CDI-associated outcomes. Analyses were performed using SAS version 9.4. During the 10-year study period, 20.1 million discharges had a cancer diagnosis. CDI developed in 1.09% of patients with cancer versus 0.77% of patients without cancer (adjusted odds ratio [aOR], 1.28; 95% CI, 1.28-1.29;<.001). The incidence of CDI in patients with cancer increased during the 10-year study period (64.7 per 10,000 discharges in 2001-2002 to 109.1 in 2009-2010; <.001). In multivariable analysis, compared with patients with cancer without CDI, patients with cancer and CDI had a longer mean LOS (5.67 days; 95% CI, 5.39-5.94) and higher rates of in-hospital mortality (aOR, 1.18; 95% CI, 1.16-1.20) and discharge to a care facility (aOR, 1.74; 95% CI, 1.72-1.75; all <.001). In this national database, CDI incidence increased significantly in patients with cancer over the study period and was associated with prolonged hospitalization, increased mortality, and discharge to a care facility. Despite increased attention, CDI remained a serious infection and merits appropriate prevention and management.

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Section: Discussionmentioning

confidence: 67%

Trends in the Incidence and Outcomes of Hospitalized Cancer Patients WithClostridium difficileInfection: A Nationwide Analysis

Gupta¹,

Tariq²,

Frank³

et al. 2017

J Natl Compr Canc Netw

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“…It has been hypothesized that PPIs alter the colonic flora by facilitating the growth of potentially pathogenic organisms in the gastrointestinal tract . A few studies reported no increased risk of developing CDI if patients are exposed to a PPI . However, significantly more clinical studies found the use of a PPI among hospitalized patients as a risk factor for the development of CDI …”

Section: Discussionmentioning

confidence: 99%

“…27,28 A few studies reported no increased risk of developing CDI if patients are exposed to a PPI. 29,30 However, significantly more clinical studies found the use of a PPI among hospitalized patients as a risk factor for the development of CDI. 14,[31][32][33][34][35] Because our study was not designed to investigate specifically why PPIs may decrease the incidence of CDI among our study patients, the rationale for this finding would require further investigation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Risk Factors forClostridium difficileInfection in Hematopoietic Stem Cell Transplant Recipients

et al. 2017

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“…Oncological patients suffer high rates of CDI due to the frequent presence of risk factors such as recurrent hospitalizations, immunosuppression, antibiotic use (either for prophylactic or therapeutic purposes), chemotherapy and the use of enteral and parenteral nutrition [ 24 ]. Despite the suggestion that patients with gastrointestinal tumors have a lesser predisposition to CDI and that patients with breast cancer are more prone to this infection, up to now, no clear relationship between the type of cancer and the risk of CDI has been described [ 25 ]. Similarly, some chemotherapy drugs, such as platinum-based agents, taxanes and DNA-topoisomerase inhibitors, have been reported to be more related to CDI than others [ 26 ].…”

Section: Infection In Oncological Patientsmentioning

confidence: 99%

“…Similarly, some chemotherapy drugs, such as platinum-based agents, taxanes and DNA-topoisomerase inhibitors, have been reported to be more related to CDI than others [ 26 ]. However, other studies did not find that any specific chemotherapy drug was especially related to a higher risk of CDI [ 25 ]. The pathogenesis of chemotherapy-related CDI is not well understood.…”

Section: Infection In Oncological Patientsmentioning

confidence: 99%

Clostridium difficile Infection in Special High-Risk Populations

2016

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Antibiotic use continues to be the most important risk factor for the development of Clostridium difficile infection (CDI) through disruption of the indigenous microbiota of the colon. This factor, together with environmental contamination, makes hospital and other healthcare facilities the perfect breeding ground for the infection. Several groups of patients are exposed to the hospital environment and, at the same time, affected by conditions that can make CDI more prevalent, more severe or make it present a different clinical picture. The list of such conditions appears too extensive to be reviewed in a single article. Nevertheless, several groups, including the critically ill, oncological patients, solid organ and hematopoietic transplant recipients, patients with inflammatory bowel disease, patients with kidney disease and pregnant women, have generated more attention and have been studied in more detail. On the other hand, pediatric patients constitute a controversial group because the large number of asymptomatic carriers makes interpretation of clinical findings and diagnostic tests difficult, as is the development of an appropriate approach to treatment. We present an in-depth discussion of CDI in these high-risk populations and we also review the issue of CDI in pediatric patients.

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Risk factors associated with Clostridium difficile infection in adult oncology patients

Abstract: We underscore the urgent need for early recognition and diagnosis of CDI in cancer patients. Our findings indicate a probable association between antibiotic use and CDI incidence, at least in certain cancer, such as breast cancer.

Cited by 46 publications

References 31 publications

Trends in the Incidence and Outcomes of Hospitalized Cancer Patients WithClostridium difficileInfection: A Nationwide Analysis

Trends in the Incidence and Outcomes of Hospitalized Cancer Patients WithClostridium difficileInfection: A Nationwide Analysis

Evaluation of Risk Factors forClostridium difficileInfection in Hematopoietic Stem Cell Transplant Recipients

Clostridium difficile Infection in Special High-Risk Populations

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