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Journal of Gastrointestinal Surgery

, Volume 16, Issue 8, pp 1566–1572 | Cite as

Chemotherapy Patients with C. difficile Colitis Have Outcomes Similar to Immunocompetent C. difficile Patients

  • David B. Stewart
  • Emmanuel Yacoub
  • Junjia Zhu
Original Article

Abstract

Background

Clostridium difficile colitis (CDC) patients receiving chemotherapy for hematologic malignancies are anticipated to have worse outcomes than immunocompetent CDC patients.

Study design

An IRB approved retrospective cohort study (2004–2009) identified an equal number (n = 49) of CDC inpatients receiving chemotherapy for hematologic malignancies (CDC-HM) as well as CDC patients without malignancies (CDC-NM). Chi-squared tests, linear regression, and analysis of variance were used to compare outcomes.

Results

No difference (p > 0.05) was noted between groups regarding age, hypertension, diabetes, COPD, or coronary artery disease. Approximately 62 % of CDC-HM patients required colony-stimulating factor for neutropenia. There was no difference (p > 0.05) in peak lactate or creatinine levels. None of the CDC-HM group required colectomy, while four CDC-NM patients required surgery (p = 0.04); neither group experienced death. No differences were noted regarding need for ICU admission for CDC or the need for vasopressors (p > 0.05). Mean hospital length of stay was longer for the CDC-HM group (22 days vs. 10 days; p = 0.001).

Conclusions

CDC-HM patients had longer lengths of stay than CDC-NM patients without an increase in rates of death, colectomy, or ICU admission. Outcomes in CDC-HM are better than many would anticipate, underscoring the current knowledge deficit regarding C. difficile infection.

Keywords

Clostridium difficile Colitis Chemotherapy Colectomy Immunosuppression Immunocompetent 

References

  1. 1.
    Bilgrami S, Feingold JM, Dorsky et al. Incidence and outcome of Clostridium difficile infection following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1999;23:1039–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Raza S, Baig MA, Russell H, Gourdet Y, Berger BJ. Clostridium difficile infection following chemotherapy. Recent Pat. Antiinfect Drug Discov 2010;5:1–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Dubberke ER, Resk KA, Srivastava A et al. Clostridium difficile-associated disease in allogenic hematopoietic stem-cell transplant recipients: risk associations, protective associations, and outcomes. Clin Transplant 2009; 24:192–98.PubMedCrossRefGoogle Scholar
  4. 4.
    Hear SR, Wren B, Barnett MJ, Thomas JM, Tabaqchali S. Clostridium difficile infection in patients with haematological malignant disease. Risk factors, faecal toxins and pathogenic strains. Epidemiol Infect 1998;100:63–72CrossRefGoogle Scholar
  5. 5.
    Hornbuckle K, Chak A, Lazarus HM, et al. Determination and validation of a predictive model for Clostridium difficile diarrhea in hospitalized oncology patients. Ann Oncol 1998;9:307–11.PubMedCrossRefGoogle Scholar
  6. 6.
    Anand A, Glatt AE. Clostridium difficile infection associated with antineoplastic chemotherapy: a review. Clin Infect Dis 1993;17:109–13.PubMedCrossRefGoogle Scholar
  7. 7.
    Johnson S, Gerding DN. Clostridium difficile-associated diarrhea. Clin Infect Dis 1998;26:1027–34.PubMedCrossRefGoogle Scholar
  8. 8.
    Wade DS, Nava HR, Douglass HOJ. Neutropenic enterocolitis clinical diagnosis and treatment. Cancer 1992;69:17–23.PubMedCrossRefGoogle Scholar
  9. 9.
    Morris-JG J, Jarvis WR, Nunez-Montiel OL, et al. Clostridium difficile: colonization and toxin production in a cohort of patients with malignant hematologic disorders. Arch Intern Med 1984;144:967–69.PubMedCrossRefGoogle Scholar
  10. 10.
    Gorschluter M, Glasmacher A, Hahn C, Schakowski F, et al. Clostridium difficile Infection in Patients with Neutropenia. Clin Infect Dis 2001;33:786–91.PubMedCrossRefGoogle Scholar
  11. 11.
    Arrango JI, Restrepo A, Schneider DL, et al. Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma. Bone Marrow Transplant 2006;37:517–21.CrossRefGoogle Scholar
  12. 12.
    Blot E, Escande MC, Besson D et al. Outbreak of Clostridium difficile-related diarrhea in an adult oncology unit: risk factors and microbiological characteristics. J Hosp Infect 2003;53:187–92.PubMedCrossRefGoogle Scholar
  13. 13.
    Karlstrom O, Fryklund B, Tullus K, et al. Swedish C. difficile study group. A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. Clin Infect Dis 1998;26:141–45.PubMedCrossRefGoogle Scholar
  14. 14.
    McDonald CL, Kilgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–41.PubMedCrossRefGoogle Scholar
  15. 15.
    Dallal RM, Harbrecht BG, Boujoukas AJ, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235:363–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Clabots CR, Johnson S., Peterson LR, Mulligan ME, et al. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992;166:561–67.PubMedCrossRefGoogle Scholar
  17. 17.
    Colarian J. Clostridium difficile colitis following antiviral therapy in the acquired immunodeficiency syndrome. Am J Med 1988;84:1081.PubMedCrossRefGoogle Scholar
  18. 18.
    McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl Med 1989;320:204–10.CrossRefGoogle Scholar
  19. 19.
    Gorschulter M, Glasmacher A, Hahn C, et al. Severe abdominal infections in neutropenic patients. Cancer Invest 2001;19:669–77.CrossRefGoogle Scholar
  20. 20.
    Chopra T, Alangaden GJ, Chandrasekar P. Clostridium difficile infection in cancer patients and hematopoietic stem cell transplant recipients. Expert Rev Anti Infect Ther 2010;8:1113–19.PubMedCrossRefGoogle Scholar
  21. 21.
    Taylor SG, Hass GM, Crumrine JL, Slaughter DP. Toxic reactions of 4-amino-pteroylglutamic acid (aminopterin) in patients with far-advanced neoplastic disease. Cancer 1950;3:493–03.PubMedCrossRefGoogle Scholar
  22. 22.
    Ishibashi N, Shoji Y. Probiotics and safety. Am J Clin Nutr 2001;73:465 S-470 S.PubMedGoogle Scholar
  23. 23.
    Kyne L, Farrell RJ, Kelly CP. Clostridium difficile .Gastroenterol Clin North Am 2001;30:753–777, IX-X.PubMedCrossRefGoogle Scholar
  24. 24.
    Cottrell GS, Amadesi S, Pikios S, Camerer E, Willardsen JA, et al. Protease-activated receptor 2, dipeptidyl peptidase I, and proteases mediate Clostridium difficile toxin A enteritis. Gastroenterology 2007;132:2422–37.PubMedCrossRefGoogle Scholar
  25. 25.
    Ausiello CM, Cerquetti M, Fedele G, Spensieri F, et al. Surface layer proteins from Clostridium difficile induce inflammatory and regulatory in human monocytes and dendritic cells. Microbes Infect 2006;8:2640–46.PubMedCrossRefGoogle Scholar
  26. 26.
    Brito GAC, Sullivan GW, Ciesla WP, HT Carper, Mandell GL, Guerrant RL. Clostridium difficile toxin A alters in-vitro adherent neutrophil morphology and function. J Infect Dis 2002;185(9):1297–306.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • David B. Stewart
    • 1
    • 2
  • Emmanuel Yacoub
    • 1
  • Junjia Zhu
    • 1
  1. 1.Department of Surgery, Division of Colorectal SurgeryThe Pennsylvania State University, College of MedicineHersheyUSA
  2. 2.Department of SurgeryPenn State College of MedicineHersheyUSA

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