Severity of Clostridium difficile–Associated Disease (CDAD) in Allogeneic Stem Cell Transplant Recipients: Evaluation of a CDAD Severity Grading System

Abstract

The purpose of this study was to develop and test a Clostridium difficile-associated disease (CDAD) grading system based on presenting symptoms in allogeneic stem cell transplant recipients. Patients with severe CDAD had significantly shorter median survival times and more adverse outcomes than patients with mild or moderate CDAD.

Reply to Jaber et al.

“…2 We agree that although diarrhea is the hallmark symptom of CDAD, a comprehensive CDAD severity grading system must also incorporate many of the symptoms that Jaber et al 1 mention. In fact, only 31 (84%) of 37 patients in our study had diarrhea that was clinically important enough to be documented in their medical charts within 48 hours of CDAD diagnosis, despite the fact that all of them had unformed stool samples collected for C. difficile toxin testing.…”

“…3 Because of space limitations, we were unable to list all of the CTCAE in our article. 2 In this letter, we provide a Table that details how the CTCAE are used in our grading system. Many of the signs and symptoms mentioned by Jaber et al 1 are part of the CTCAE for colitis.…”

“…These results coincide with those of other studies on C. difficile spores that have been conducted using chlorine-based germicides at the recommended working strength and with recommendations by the Centers for Disease Control and Prevention. 2 " 6 Studies such as these provide valuable information for infection control professionals in healthcare facilities, especially since the US Enivornmental Protection Agency does not currently recognize a test method for inactivation of C. difficile spores.…”

Is Diarrhea Enough to Assess the Severity of Clostridium difficile–Associated Disease?

“…Both the frequency and severity of C. difficile colitis are increasing. 2 " 4 We read the article by Dubberke et al 5 with interest. The authors developed a severity grading system for Clostridium difficile-associated disease (CDAD) by modifying the criteria given for grading diarrhea and colitis in the National Cancer severity grading system identified patients at high risk for adverse outcomes after CDAD on the basis of presenting symptoms.…”

“…3,10 A lactate level higher than 5 mmol/L was associated with increased mortality. 10 Thus, we believe that in addition to the grading system developed by Dubberke et al, 5 one also needs to factor in the above-mentioned clinical, hemodynamic, and laboratory parameters when assessing the severity of CDAD.…”