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Impact of malignancy on Clostridium difficile infection

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to investigate the impact of malignancy and chemotherapy on the clinical and microbiological characteristics of Clostridium difficile infections (CDI).

Methods

CDI patients with a history of malignancy within 5 years were defined as the cancer group. The characteristics of the patients were compared according to the presence of malignancy.

Results

Of 580 patients with CDI, 159 (27.4 %) belonged to the cancer group and 421 (72.6 %) to the non-cancer group. More of the patients in the cancer group than those in the non-cancer group had been hospitalized within the prior 2 months (P < 0.001). Leukocytosis was more common in the non-cancer group (P = 0.034), while infection by PCR ribotype 017 strains was more common in the cancer group, with marginal significance (P = 0.07). Recurrence was more frequent in the cancer group (20.4 % vs. 9.5 %, P =0.005) and cancer was an independent risk factor for recurrence of CDI (OR = 2.66, 95 % CI 1.34-5.29, P =0.005). Age also contributed to the recurrence of CDI (OR = 1.03, 95 % CI 1.00-1.06, P =0.026).

Conclusions

Malignancy and age are independent risk factors for recurrence of CDI. Cancer patients require careful observation for recurrence after treatment of CDI.

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References

  1. Kelly CP, LaMont JT (2008) Clostridium difficile—more difficult than ever. N Engl J Med 359(18):1932–1940. doi:10.1056/NEJMra0707500

    Article  CAS  PubMed  Google Scholar 

  2. Monge D, Millan I, Gonzalez-Escalada A, Asensio A (2013) The effect of Clostridium difficile infection on length of hospital stay. A cohort study. Enferm Infecc Microbiol Clin 31(10):660–664. doi:10.1016/j.eimc.2012.11.007

    Article  PubMed  Google Scholar 

  3. McFarland LV, Mulligan ME, Kwok RY, Stamm WE (1989) Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 320(4):204–210. doi:10.1056/NEJM198901263200402

    Article  CAS  PubMed  Google Scholar 

  4. Bartlett JG, Gerding DN (2008) Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis 46(Suppl 1):S12–S18. doi:10.1086/521863

    Article  PubMed  Google Scholar 

  5. Kamthan AG, Bruckner HW, Hirschman SZ, Agus SG (1992) Clostridium difficile diarrhea induced by cancer chemotherapy. Arch Intern Med 152(8):1715–1717

    Article  CAS  PubMed  Google Scholar 

  6. Husain A, Aptaker L, Spriggs DR, Barakat RR (1998) Gastrointestinal toxicity and Clostridium difficile diarrhea in patients treated with paclitaxel-containing chemotherapy regimens. Gynecol Oncol 71(1):104–107. doi:10.1006/gyno.1998.5158

    Article  CAS  PubMed  Google Scholar 

  7. Khan A, Raza S, Batul SA, Khan M, Aksoy T, Baig MA, Berger BJ (2012) The evolution of Clostridium difficile infection in cancer patients: epidemiology, pathophysiology, and guidelines for prevention and management. Recent Patents Anti-infective Drug Discovery 7(2):157–170

    Article  CAS  Google Scholar 

  8. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380(9836):37–43. doi:10.1016/S0140-6736(12)60240-2

    Article  PubMed  Google Scholar 

  9. Rodriguez Garzotto A, Merida Garcia A, Munoz Unceta N, Galera Lopez MM, Orellana-Miguel MA, Diaz-Garcia CV, Cortijo-Cascajares S, Cortes-Funes H, Agullo-Ortuno MT (2015) Risk factors associated with Clostridium difficile infection in adult oncology patients. Supportive Care Cancer: Off J Multinational Assoc Support Care Cancer 23(6):1569–1577. doi:10.1007/s00520-014-2506-7

    Article  Google Scholar 

  10. Yoon YK, Kim MJ, Sohn JW, Kim HS, Choi YJ, Kim JS, Kim ST, Park KH, Kim SJ, Kim BS, Shin SW, Kim YH, Park Y (2014) Predictors of mortality attributable to Clostridium difficile infection in patients with underlying malignancy. Supportive Care Cancer: Off J Multinational Assoc Supportive Care Cancer 22(8):2039–2048. doi:10.1007/s00520-014-2174-7

    Article  Google Scholar 

  11. Krishna SG, Zhao W, Apewokin SK, Krishna K, Chepyala P, Anaissie EJ (2013) Risk factors, preemptive therapy, and antiperistaltic agents for Clostridium difficile infection in cancer patients. Transplant Infect Dis 15(5):493–501. doi:10.1111/tid.12112

    CAS  Google Scholar 

  12. Hwang KE, Hwang YR, Seol CH, Park C, Park SH, Yoon KH, Park DS, Lee MK, Jeong ET, Kim HR (2013) Clostridium difficile Infection in lung cancer patients. Jpn J Infect Dis 66(5):379–382

    Article  PubMed  Google Scholar 

  13. Gravel D, Miller M, Simor A, Taylor G, Gardam M, McGeer A, Hutchinson J, Moore D, Kelly S, Boyd D, Mulvey M, Canadian Nosocomial Infection Surveillance P (2009) Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program Study. Clinical Infect Dis 48(5):568–576. doi:10.1086/596703

    Article  Google Scholar 

  14. Barbut F, Richard A, Hamadi K, Chomette V, Burghoffer B, Petit JC (2000) Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea. J Clin Microbiol 38(6):2386–2388

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Kuijper EJ, Coignard B, Tull P (2006) Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect 12(Suppl 6):2–18. doi:10.1111/j.1469-0691.2006.01580.x

    Article  CAS  PubMed  Google Scholar 

  16. Zar FA, Bakkanagari SR, Moorthi KM, Davis MB (2007) A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 45(3):302–307. doi:10.1086/519265

    Article  CAS  PubMed  Google Scholar 

  17. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH (2010) Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 31(5):431–455. doi:10.1086/651706

    Article  PubMed  Google Scholar 

  18. O’Connor JR, Johnson S, Gerding DN (2009) Clostridium difficile infection caused by the epidemic BI/NAP1/027 strain. Gastroenterology 136(6):1913–1924. doi:10.1053/j.gastro.2009.02.073

    Article  PubMed  Google Scholar 

  19. Aspinall ST, Hutchinson DN (1992) New selective medium for isolating Clostridium difficile from faeces. J Clin Pathol 45(9):812–814

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Persson S, Torpdahl M, Olsen KE (2008) New multiplex PCR method for the detection of Clostridium difficile toxin A (tcdA) and toxin B (tcdB) and the binary toxin (cdtA/cdtB) genes applied to a Danish strain collection. Clin Microbiol Infect 14(11):1057–1064. doi:10.1111/j.1469-0691.2008.02092.x

    Article  CAS  PubMed  Google Scholar 

  21. Bidet P, Barbut F, Lalande V, Burghoffer B, Petit JC (1999) Development of a new PCR-ribotyping method for Clostridium difficile based on ribosomal RNA gene sequencing. FEMS Microbiol Lett 175(2):261–266

    Article  CAS  PubMed  Google Scholar 

  22. Chopra T, Alangaden GJ, Chandrasekar P (2010) Clostridium difficile infection in cancer patients and hematopoietic stem cell transplant recipients. Expert Rev Anti-Infect Ther 8(10):1113–1119. doi:10.1586/eri.10.95

    Article  PubMed  Google Scholar 

  23. Maroo S, Lamont JT (2006) Recurrent clostridium difficile. Gastroenterology 130(4):1311–1316. doi:10.1053/j.gastro.2006.02.044

    Article  PubMed  Google Scholar 

  24. Garey KW, Sethi S, Yadav Y, DuPont HL (2008) Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect 70(4):298–304. doi:10.1016/j.jhin.2008.08.012

    Article  CAS  PubMed  Google Scholar 

  25. Marsh JW, Arora R, Schlackman JL, Shutt KA, Curry SR, Harrison LH (2012) Association of relapse of Clostridium difficile disease with BI/NAP1/027. J Clin Microbiol 50(12):4078–4082. doi:10.1128/jcm.02291-12

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kim J, Pai H, Seo MR, Kang JO (2011) Epidemiology and clinical characteristics of Clostridium difficile infection in a Korean tertiary hospital. J Korean Med Sci 26(10):1258–1264. doi:10.3346/jkms.2011.26.10.1258

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lee JH, Lee SY, Kim YS, Park SW, Park SW, Jo SY, Ryu SH, Lee JH, Moon JS, Whang DH, Shin BM (2010) The incidence and clinical features of Clostridium difficile infection; single center study. Kor J Gastroenterol (Taehan Sohwagi Hakhoe Chi) 55(3):175–182

    Article  Google Scholar 

  28. Johnson S (2009) Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect 58(6):403–410. doi:10.1016/j.jinf.2009.03.010

    Article  PubMed  Google Scholar 

  29. Kelly CP (2012) Can we identify patients at high risk of recurrent Clostridium difficile infection? Clin Microbiol Infect 18(Suppl 6):21–27. doi:10.1111/1469-0691.12046

    Article  PubMed  Google Scholar 

  30. Bishop KD, Castillo JJ (2012) Risk factors associated with Clostridium difficile infection in adult oncology patients with a history of recent hospitalization for febrile neutropenia. Leuk Lymphoma 53(8):1617–1619. doi:10.3109/10428194.2012.654472

    Article  PubMed  Google Scholar 

  31. Loo VG, Bourgault AM, Poirier L, Lamothe F, Michaud S, Turgeon N, Toye B, Beaudoin A, Frost EH, Gilca R, Brassard P, Dendukuri N, Beliveau C, Oughton M, Brukner I, Dascal A (2011) Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 365(18):1693–1703. doi:10.1056/NEJMoa1012413

    Article  CAS  PubMed  Google Scholar 

  32. Kim J, Kang JO, Kim H, Seo MR, Choi TY, Pai H, Kuijper EJ, Sanders I, Fawley W (2013) Epidemiology of Clostridium difficile infections in a tertiary-care hospital in Korea. Clin Microbiol Infect 19(6):521–527. doi:10.1111/j.1469-0691.2012.03910.x

    Article  CAS  PubMed  Google Scholar 

  33. Kim J, Seo MR, Kang JO, Kim Y, Hong SP, Pai H (2014) Clinical characteristics of relapses and re-infections in Clostridium difficile infection. Clin Microbiol Infect 20(11):1198–1204. doi:10.1111/1469-0691.12704

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Funding

This work was supported by the research fund of Hanyang University (HY-2011).

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Corresponding author

Correspondence to H. Pai.

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Conflict of interest

None.

Ethical approval

This study was approved by the institutional review board of Hanyang University Hospital (HYUH IRB 2013-07-016)

Informed consent

Waived.

Additional information

M. S. Chung and J. Kim contributed equally to this work.

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Chung, M.S., Kim, J., Kang, J.O. et al. Impact of malignancy on Clostridium difficile infection. Eur J Clin Microbiol Infect Dis 35, 1771–1776 (2016). https://doi.org/10.1007/s10096-016-2725-6

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  • DOI: https://doi.org/10.1007/s10096-016-2725-6

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