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

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§‖

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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.

© 2013 Lippincott Williams & Wilkins, Inc.

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