Skip to main content

Advertisement

SpringerLink
Log in

Excess risk of Clostridium difficile infection in ovarian cancer is related to exposure to broad-spectrum antibiotics

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study was to determine if a diagnosis of ovarian cancer is independently associated with an increased risk of Clostridium difficile infection (CDI).

Methods

The University HealthSystem Consortium database was queried to perform a retrospective cohort study of women with and without ovarian cancer who were diagnosed with CDI. Inpatients undergoing total hysterectomy from 2008 to 2012 were studied. Ovarian cancer patients were compared to non-ovarian cancer patients to evaluate relative risk (RR) of CDI. Adjustment was made for known or suspected CDI risk factors to determine RR of CDI independent of these variables.

Results

In this study, 115,203 patients were included. CDI was reported in 0.80 % of ovarian cancer patients and in 0.31 % of non-ovarian cancer patients (RR = 2.50; 95 % confidence interval (CI) = 2.02 to 3.35). Stratification by age, presence of other comorbidities, or administration of antineoplastic drugs did not significantly modify the elevated risk associated with ovarian cancer. Significantly increased risk in ovarian cancer patients was no longer observed after controlling for broad-spectrum antibiotic administration (RR = 1.28, 95 % CI = 0.39 to 4.13). Compared to non-ovarian cancer patients, ovarian cancer patients were more frequently treated with broad-spectrum antibiotics, had a 39 % longer mean duration of therapy, and had 2.5-fold greater mean total exposure to broad-spectrum antibiotics.

Conclusions

After adjustment for antibiotic use, ovarian cancer patients are not at excess risk of CDI. Additional studies are needed to understand the patterns of broad-spectrum antibiotic prescription for ovarian cancer patients leading to increased exposure. If feasible, reduction of this exposure may decrease morbidity in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lipp MJ, Nero DC, Callahan MA (2012) Impact of hospital-acquired Clostridium difficile. J Gastroenterol Hepatol 27(11):1733–1737. doi:10.1111/j.1440-1746.2012.07242.x

    Article  PubMed  Google Scholar 

  2. Kyne L, Sougioultzis S, McFarland LV, Kelly CP (2002) Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol 23(11):653–659. doi:10.1086/501989

    Article  PubMed  Google Scholar 

  3. Kelly CP, Pothoulakis C, LaMont JT (1994) Clostridium difficile colitis. N Engl J Med 330(4):257–262. doi:10.1056/nejm199401273300406

    Article  PubMed  CAS  Google Scholar 

  4. Ricciardi R, Rothenberger DA, Madoff RD, Baxter NN (2007) Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 142(7):624–631. doi:10.1001/archsurg.142.7.624

    Article  PubMed  Google Scholar 

  5. Zerey M, Paton BL, Lincourt AE, Gersin KS, Kercher KW, Heniford BT (2007) The burden of Clostridium difficile in surgical patients in the United States. Surg Infect (Larchmt) 8(6):557–566. doi:10.1089/sur.2006.062

    Article  Google Scholar 

  6. Lo Vecchio A, Zacur GM (2012) Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol 28(1):1–9. doi:10.1097/MOG.0b013e32834bc9a9

    Article  PubMed  Google Scholar 

  7. McCollum DL, Rodriguez JM (2012) Detection, treatment, and prevention of Clostridium difficile infection. Clin Gastroenterol Hepatol 10(6):581–592. doi:10.1016/j.cgh.2012.03.008

    Article  PubMed  Google Scholar 

  8. Hensgens MP, Goorhuis A, Dekkers OM, Kuijper EJ (2012) Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. J Antimicrob Chemother 67(3):742–748. doi:10.1093/jac/dkr508

    Article  PubMed  CAS  Google Scholar 

  9. Owens RC Jr, Donskey CJ, Gaynes RP, Loo VG, Muto CA (2008) Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 46(Suppl 1):S19–31. doi:10.1086/521859

    Article  PubMed  Google Scholar 

  10. Wistrom J, Norrby SR, Myhre EB, Eriksson S, Granstrom G, Lagergren L, Englund G, Nord CE, Svenungsson B (2001) Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother 47(1):43–50. doi:10.1093/jac/47.1.43

    Article  PubMed  CAS  Google Scholar 

  11. Dubberke ER, Reske KA, Yan Y, Olsen MA, McDonald LC, Fraser VJ (2007) Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis 45(12):1543–1549. doi:10.1086/523582

    Article  PubMed  Google Scholar 

  12. Emoto M, Kawarabayashi T, Hachisuga MD, Eguchi F, Shirakawa K (1996) Clostridium difficile colitis associated with cisplatin-based chemotherapy in ovarian cancer patients. Gynecol Oncol 61(3):369–372

    Article  PubMed  CAS  Google Scholar 

  13. Masciullo V, Mainenti S, Lorusso D, Margariti PA, Scambia G (2010) Lethal Clostridium difficile colitis associated with paclitaxel and carboplatin chemotherapy in ovarian carcinoma: case report and review of the literature. Obstet Gynecol Int 2010. doi:10.1155/2010/74978

  14. Southern WN, Rahmani R, Aroniadis O, Khorshidi I, Thanjan A, Ibrahim C, Brandt LJ (2010) Postoperative Clostridium difficile-associated diarrhea. Surgery 148(1):24–30. doi:10.1016/j.surg.2009.11.021

    Article  PubMed  Google Scholar 

  15. Carignan A, Allard C, Pepin J, Cossette B, Nault V, Valiquette L (2008) Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain. Clin Infect Dis 46(12):1838–1843. doi:10.1086/588291

    Article  PubMed  Google Scholar 

  16. Fowler S, Webber A, Cooper BS, Phimister A, Price K, Carter Y, Kibbler CC, Simpson AJ, Stone SP (2007) Successful use of feedback to improve antibiotic prescribing and reduce Clostridium difficile infection: a controlled interrupted time series. J Antimicrob Chemother 59(5):990–995. doi:10.1093/jac/dkm014

    Article  PubMed  CAS  Google Scholar 

  17. Talpaert MJ, Gopal Rao G, Cooper BS, Wade P (2011) Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother 66(9):2168–2174. doi:10.1093/jac/dkr253

    Article  PubMed  CAS  Google Scholar 

  18. Aldeyab MA, Kearney MP, Scott MG, Aldiab MA, Alahmadi YM, Darwish Elhajji FW, Magee FA, McElnay JC (2012) An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. J Antimicrob Chemother 67(12):2988–2996. doi:10.1093/jac/dks330

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Reproductive Medicine, Division of Gynecologic Oncology, Rebecca and John Moores UCSD Cancer Center, 3855 Health Sciences Dr., #0987, La Jolla, CA, 92093-0987, USA

    Josephine S. Kim, Kristy K. Ward, Nina R. Shah, Cheryl C. Saenz, Michael T. McHale & Steven C. Plaxe

Authors
  1. Josephine S. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristy K. Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nina R. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheryl C. Saenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael T. McHale
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven C. Plaxe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Josephine S. Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, J.S., Ward, K.K., Shah, N.R. et al. Excess risk of Clostridium difficile infection in ovarian cancer is related to exposure to broad-spectrum antibiotics. Support Care Cancer 21, 3103–3107 (2013). https://doi.org/10.1007/s00520-013-1888-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-1888-2

Keywords

Search

Navigation