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Clostridium difficile Infection in Pediatric Acute Myeloid Leukemia: From The Canadian Infections in Acute Myeloid Leukemia Research Group

Price, Victoria MB ChB*; Portwine, Carol PhD; Zelcer, Shayna MD; Ethier, Marie-Chantal BSc§; Gillmeister, Biljana MSc§; Silva, Mariana MD; Schindera, Christina MD; Yanofsky, Rochelle MD**; Mitchell, David MD††; Johnston, Donna L. MD‡‡; Lewis, Victor MD§§; Dix, David MD¶¶; Cellot, Sonia MD‖‖; Michon, Bruno MD***; Bowes, Lynette MD†††; Stobart, Kent MD‡‡‡; Brossard, Josee MD§§§; Beyene, Joseph PhD§¶¶¶; Sung, Lillian PhD§‖

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31828690a4
Original Studies
Abstract

Background: The prevalence and severity of Clostridium difficile infection (CDI) has increased over time in adult patients, but little is known about CDI in pediatric cancer. The primary objectives were to describe the incidence and characteristics of CDI in children with de novo acute myeloid leukemia (AML). The secondary objective was to describe factors associated with CDI.

Method: We performed a multicenter, retrospective cohort study of children with de novo AML and evaluated CDI. Recurrence, sepsis and infection-related death were examined. Factors associated with CDI were also evaluated.

Results: Forty-three CDI occurred in 37 of 341 (10.9%) patients during 42 of 1277 (3.3%) courses of chemotherapy. There were 6 children with multiple episodes of CDI. Three infections were associated with sepsis, and no children died of CDI. Only 2 children had an associated enterocolitis. Both days of broad-spectrum antibiotics (odds ratio 1.03, 95% confidence interval: 1.01 to 1.06; P = 0.003) and at least 1 microbiologically documented sterile site infection (odds ratio 10.81, 95% confidence interval: 5.88 to 19.89; P < 0.0001) were independently associated with CDI.

Conclusions: CDI occurred in 11% of children receiving intensive chemotherapy for AML, and outcomes were not severe. CDI is not a prominent issue in pediatric AML in terms of prevalence, incidence or associated outcomes.

Author Information

From the *Pediatrics, IWK Health Centre, Canada; Hematology/Oncology, McMaster Children’s Hospital at Hamilton Health Sciences, Canada; Hematology/Oncology, London Health Sciences, Canada; §Child Health Evaluative Sciences, The Hospital for Sick Children, Canada; Hematology/Oncology, Cancer Centre of Southeastern Ontario at Kingston, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Canada; **Hematology/Oncology, CancerCare Manitoba, Canada; ††Hematology/Oncology, Montreal Children’s Hospital, Canada; ‡‡Hematology Oncology, Children’s Hospital of Eastern Ontario, Canada; §§Hematology/Oncology/Transplant Program, Alberta Children’s Hospital, Canada; ¶¶Pediatric Hematology/Oncology, British Columbia Children’s Hospital, Canada; ‖‖Hematology/Oncology, Hospital Sainte-Justine, Canada; ***Pediatric Hematology/Oncology Centre, Hospitalier Universitaire de Quebec, Canada; †††Hematology/Oncology, Janeway Child Health Centre, Canada; ‡‡‡Stollery Children’s Hospital, University of Alberta Hospital, Canada; §§§Hematology/Oncology, Centre Hospitalier Universitaire de Sherbrooke, Canada; and ¶¶¶Population Genomics Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada.

Accepted for publication January 07, 2013.

This research was funded by the Canadian Cancer Society (Grant #019468) and the C17 Research Network. L.S. is supported by a New Investigator Award from the Canadian Institutes of Health Research. All authors contributed to data collection and article writing. Jo.Be. and L.S. contributed to data analysis and interpretation, and B.G., M.-C.E. and L.S. also contributed to study conception and design. All authors have approved the final version of the article. The authors have no other funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Lillian Sung, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8. E-mail: lillian.sung@sickkids.ca.

© 2013 Lippincott Williams & Wilkins, Inc.