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Risks factors and outcomes of Clostridium difficile infection in patients with cancer: a matched case-control study

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Abstract

Purpose

Clostridium difficile infection (CDI) is the leading cause of diarrhoea in hospitalised patients. Cancer populations are at high-risk for infection, but comprehensive evaluation in the current era of cancer care has not been performed. The objective of this study was to describe characteristics, risk factors, and outcomes of CDI in cancer patients.

Methods

Fifty consecutive patients with CDI at a large Australian cancer centre (2013–2015) were identified from the hospital pathology database. Each case was matched by ward and hospital admission date to three controls without toxigenic CDI. Treatment and outcomes of infection were evaluated and potential risk factors were analysed using conditional logistic regression.

Results

Patients with CDI had a mean age of 59.7 years and 74% had an underlying solid tumour. Healthcare-associated infection comprised 80% of cases. Recurrence occurred in 10, and 12% of cases were admitted to ICU within 30 days. Severe or severe-complicated infection was observed in 32%. Independent risk factors for infection included chemotherapy (odds ratio (OR) 3.82, 95% CI 1.67–8.75; p = 0.002), gastro-intestinal/abdominal surgery (OR 4.64, 95% CI 1.20–17.91; p = 0.03), proton pump inhibitor (PPI) therapy (OR 2.47, 95% CI 1.05–5.80; p = 0.04), and days of antibiotic therapy (OR 1.04, 95% CI 1.01–1.08; p = 0.02).

Conclusions

Severe or complicated infections are frequent in patients with cancer who develop CDI. Receipt of chemotherapy, gastro-intestinal/abdominal surgery, PPI therapy, and antibiotic exposure contribute to infection risk. More effective CDI therapy for cancer patients is required and dedicated antibiotic stewardship programs in high-risk cancer populations are needed to ameliorate infection risk.

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Acknowledgements

Authors acknowledge the assistance of Jennifer Breen, Kee Ming, Badal Bhatt and Malcolm Eaton for extraction of surveillance and laboratory data.

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Authors and Affiliations

  1. Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Locked Bag 1 A’Beckett Street, Melbourne, VIC, 8006, Australia

    Andrew I.T. Hebbard, Monica A. Slavin, Jason A. Trubiano, Benjamin W. Teh, Gabrielle M. Haeusler, Karin A. Thursky & Leon J. Worth

  2. Centre for Improving Cancer Outcomes through Enhanced Infection Services, National Health and Medical Research Council Centre of Research Excellence, The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

    Monica A. Slavin, Karin A. Thursky & Leon J. Worth

  3. Microbiology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Caroline Reed

  4. Victorian Healthcare Associated Infection Surveillance System (VICNISS), Doherty Institute, Melbourne, VIC, Australia

    Leon J. Worth

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  1. Andrew I.T. Hebbard
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  2. Monica A. Slavin
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  3. Caroline Reed
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  4. Jason A. Trubiano
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Correspondence to Leon J. Worth.

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Hebbard, A.I., Slavin, M.A., Reed, C. et al. Risks factors and outcomes of Clostridium difficile infection in patients with cancer: a matched case-control study. Support Care Cancer 25, 1923–1930 (2017). https://doi.org/10.1007/s00520-017-3606-y

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  • DOI: https://doi.org/10.1007/s00520-017-3606-y

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