Risk factors, outcomes and epidemiology associated with Clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in China

Abstract

The purpose of this study was to evaluate the risk factors, outcomes and epidemiology associated with Clostridium difficile infection (CDI) in patients with haematological malignancies in a tertiary care hospital in China. C. difficile screening was performed on patients admitted for chemotherapy or haematopoietic stem cell transplantation between 2009 and 2013. C. difficile isolates were analysed by multilocus sequence typing, and a retrospective chart review was performed on all patients with a positive toxin assay. CDI was diagnosed in 21 haematologyoncology ward patients and 14 marrow transplantation service patients for a cumulative incidence of 1.89/1000 and 3.69/1000 patient-days, respectively. Univariate analyses showed that patients who received etoposide had an increased risk of CDI (odds ratio 4.25, 95 % confidence interval 1.32-13.64). There was only one patient death, for which CDI was not the primary cause. Ten sequence types (STs) were identified, of which ST-3 and ST-54 were the most common; the hypervirulent ST-1 (ribotype 027) and ST-11 (ribotype 078) C. difficile strains were not detected in the patients in this study. The incidence of CDI did not differ between patients receiving chemotherapy and those receiving haematopoietic stem cell transplantation. The only risk factor for chemotherapy patients was treatment with etoposide.

Adaptive immune response to Clostridium difficile infection: A perspective for prevention and therapy

“…It was the first study to directly compare CDI outcomes after metronidazole, vancomycin, or combination therapy in patients with hematologic malignancies; 18.7% of patients (73/390) had CDI compared to the 7.0% of patients in the aforementioned study [35]. Similar results were concluded by Gu et al in 2015, who studied patients undergoing chemotherapy for haematological malignancies; 21% (21/97) of patients were diagnosed with CDI [36]. Some of the differences in reported incidence among these studies could be due to changing diagnostic algorithms over time.…”

“…administration, the nanoparticle vaccine offered full protection from C. difficile, and provided long lasting Ab titers against antigen, compared to aluminum adjuvanted rTcdB [45]. Hong and colleagues developed a Bacillus subtilis spore-based oral vaccine consisting of a specific region of TcdA CBD (TcdA [26][27][28][29][30][31][32][33][34][35][36][37][38][39] ) and tested its efficacy in a hamster model. Hamsters immunized with the oral vaccine and challenged with C. difficile developed anti-TcdA CBD mucosal Abs that prevented colonization of C. difficile.…”

“…Hamsters immunized with the oral vaccine and challenged with C. difficile developed anti-TcdA CBD mucosal Abs that prevented colonization of C. difficile. Moreover, Abs to both recombinant TcdA and TcdA [26][27][28][29][30][31][32][33][34][35][36][37][38][39] were cross reactive with unrelated proteins expressed on the surface of both vegetative and spore forms of C.difficile [46]. Thus, mucosal immunity via anti-TcdA Abs may offer protection to multiple facets of CDI pathogenesis, including toxicity and colonization.…”

Nosocomial infections and their control strategies

“…Cephalosporins, fluoroquinolones, clindamycins and ampicillins are those antimicrobials that are usually employed for C. difficile-associated diseases. Recent studies reported that the improper antibiotic use was the cause of increasing infections of C. difficile [28] .…”

“…Inanimate objects and infected intestinal patients are major sites acted as reservoirs. Hospital staff along with hospital settings are also playing their part to a greater extent [28].…”