Clostridium difficile Infection More Prevalent In Patients Undergoing Allogeneic Stem Cell Transplantation

Clostridium difficile infection was more prevalent in patients undergoing allogeneic stem cell transplantation compared with patients undergoing autologous stem cell transplantation, according to findings published in Infection Control & Hospital Epidemiology.

 

C. difficile infection is the most common cause of infectious diarrhea in hospitalized patients,” Nishi N. Shah, MD, MPH, resident at the University of Arkansas for Medical Sciences, Little Rock, Arkansas and colleagues wrote. “Epidemiological studies evaluating the incidence of and morbidity and mortality due to C. difficile infection in hematopoietic stem cell transplant recipients are limited.”

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The researchers reviewed patient data from the NIS database, analyzing records on adults admitted for allogeneic stem cell transplantation (n = 33,189) and autologous stem cell transplantation (n = 53,072) between January 2001, and December 2010.

Most patients had received autologous stem cell transplantation (61.5%). Of patients in the allogeneic group, 8.5% had C. difficile infection, compared with 5.8% in the autologous group, the researchers reported. Shah and colleagues wrote that univariate analyses identified a number of risk factors for C. difficile infection, including: age, gender, indication for stem cell transplantation, radiation as part of the conditioning regimen, respiratory failure, septicemia and lengthy hospital stay.

Multivariate analyses for autologous transplantation showed significant correlation between age and indication for transplant, but this indication was not associated with C. difficile infection in either group upon multivariate analysis.

Through multivariate analysis, the researchers found multiple factors associated with C. difficile infection: septicemia (autologous OR = 1.64; 95% CI, 1.35-2; allogeneic OR = 1.69; 95% CI, 1.36-2.1), male gender (autologous OR = 1.29; 95% CI, 1.09-1.53; allogeneic OR = 1.36; 95% CI, 1.18-1.57), lengthy hospital stay (autologous OR = 2.81; 95% CI, 2.29-3.45; allogeneic OR = 2.63; 95% CI, 2.15-3.22) and presence of multiple comorbidities (autologous OR = 1.32; 95% CI, 1.11-1.57; allogeneic OR = 1.18; 95% CI, 1-1.4).

“The current study helps identify higher risk groups for such clinical interventions. Among allogeneic stem cell transplantation recipients, interventions to reduce or treat gut GVHD could also impact C. difficile infection rates,” the researchers wrote. “Many topics of study remain to be explored in the prevention of C. difficile infection among stem cell transplantation patients. Certainly, further interventions to improve outcomes, such as reducing the rate of C. difficile infection, are needed.” – by Andy Polhamus