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A Single-Center Experience and Literature Review of Management Strategies for Clostridium difficile Infection in Hematopoietic Stem Cell Transplant Patients

Majeed, Aneela MD, FACP*; Larriva, Marti M. PharmD; Iftikhar, Ahmad MD; Mushtaq, Adeela MD§; Campbell, Patrick PharmD; Malik, Mustafa Nadeem MD; Rafae, Abdul MD; Zar, Muhammad Abu MD; Kamal, Ahmad MD#; Lakhani, Midhat MD**; Khalid, Nageena Rani MD**; Zangeneh, Tirdad T. MD, FACP††; Anwer, Faiz MD, FACP**,‡‡

Infectious Diseases in Clinical Practice: January 2020 - Volume 28 - Issue 1 - p 10–15
doi: 10.1097/IPC.0000000000000798
Original Articles
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Introduction The aim of our study is to evaluate risk factors associated with the development of Clostridium difficile infection (CDI) in hematopoietic stem cell transplant (HSCT) patients, determine its incidence, and report outcomes of CDI in our patient population.

Methods We performed a retrospective review of medical records of adult HSCT recipients diagnosed between 2013 and 2016 at our center. Logistic regression models were used to determine the relationship between risk factors and the odds of CDI.

Results The overall incidence of CDI in HSCT patients was 9.4%. The incidence of CDI was higher in allogeneic HSCT (20%) versus autologous HSCT (4.8%). No statistically significant differences in age, sex, cancer type, and transplant type were found between those who developed CDI and those who did not. However, patients with CDI had a longer length of stay (25 days) and used more antibiotics (30 days prior to and during admission for HSCT) than non-CDI patients (19 days). Only 2 of 17 patients (11.8%) with CDI experienced recurrence among 180 patients after HSCT. No patient suffered from toxic megacolon or ileus, and no patient underwent colectomy. There was no mortality associated with CDI at our center.

Conclusions Clostridium difficile infection has an incidence rate of 9.4% in HSCT recipients. Established risk factors including age, sex, cancer type, and transplant type were not identified as risk factors in our population. However, longer LOS and use of more than 4 lines of antibiotics were observed among those with CDI compared with those without CDI.

The overall incidence of Clostridium diffi cile infection (CDI) at the authors’ institution was 9.4%. Longer length of stay and use of greater than four lines of antibiotics were identifi ed as risk factors. Only two of 17 patients (11.8%) with CDI experienced recurrence among 180 patients after hematopoietic stem cell transplantation. No patient suffered from toxic megacolon or ileus or underwent colectomy, and there was no mortality associated with CDI.

From the *Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA

Departments of Pharmacy

Medicine, University of Arizona, Tucson, AZ

§Department of Medicine, University of Pittsburgh Medical Center, McKeesport, PA

Department of Medicine, McLaren-Flint, Michigan State University, Flint, MI

Department of Medicine, Jacobi Medical Center, Bronx

#Department of Medicine, Suny Downstate Medical Center, Brooklyn, NY

Divisions of **Hematology and Oncology

††Infectious Diseases, Department of Medicine, University of Arizona, Tucson, AZ

‡‡Taussig Cancer Center, Department of Hematology, Medical Oncology, Cleveland Clinic, Cleveland, OH.

Correspondence to: Faiz Anwer, MD, FACP, Cleveland Clinic, Taussig Cancer Center, 9500 Euclid Ave/CA60, 10201 Carnegie Ave, Cleveland, OH 44195. E-mail: anwerf@ccf.org.

This work was supported in part by grant P30 CA023074 from the National Cancer Institute, National Institutes of Health, Bethesda, MD.

The authors have no funding or conflicts of interest to disclose.

Online date: November 15, 2019

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