Andrew I T Hebbard1, Monica A Slavin1,2, Caroline Reed3, Jason A Trubiano1, Benjamin W Teh1, Gabrielle M Haeusler1, Karin A Thursky1,2, Leon J Worth4,5,6. 1. Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Locked Bag 1 A'Beckett Street, Melbourne, VIC, 8006, Australia. 2. Centre for Improving Cancer Outcomes through Enhanced Infection Services, National Health and Medical Research Council Centre of Research Excellence, The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia. 3. Microbiology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. 4. Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Locked Bag 1 A'Beckett Street, Melbourne, VIC, 8006, Australia. Leon.Worth@Petermac.org. 5. Centre for Improving Cancer Outcomes through Enhanced Infection Services, National Health and Medical Research Council Centre of Research Excellence, The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia. Leon.Worth@Petermac.org. 6. Victorian Healthcare Associated Infection Surveillance System (VICNISS), Doherty Institute, Melbourne, VIC, Australia. Leon.Worth@Petermac.org.
Abstract
PURPOSE: Clostridium difficile infection (CDI) is the leading cause of diarrhoea in hospitalised patients. Cancer populations are at high-risk for infection, but comprehensive evaluation in the current era of cancer care has not been performed. The objective of this study was to describe characteristics, risk factors, and outcomes of CDI in cancer patients. METHODS: Fifty consecutive patients with CDI at a large Australian cancer centre (2013-2015) were identified from the hospital pathology database. Each case was matched by ward and hospital admission date to three controls without toxigenic CDI. Treatment and outcomes of infection were evaluated and potential risk factors were analysed using conditional logistic regression. RESULTS: Patients with CDI had a mean age of 59.7 years and 74% had an underlying solid tumour. Healthcare-associated infection comprised 80% of cases. Recurrence occurred in 10, and 12% of cases were admitted to ICU within 30 days. Severe or severe-complicated infection was observed in 32%. Independent risk factors for infection included chemotherapy (odds ratio (OR) 3.82, 95% CI 1.67-8.75; p = 0.002), gastro-intestinal/abdominal surgery (OR 4.64, 95% CI 1.20-17.91; p = 0.03), proton pump inhibitor (PPI) therapy (OR 2.47, 95% CI 1.05-5.80; p = 0.04), and days of antibiotic therapy (OR 1.04, 95% CI 1.01-1.08; p = 0.02). CONCLUSIONS: Severe or complicated infections are frequent in patients with cancer who develop CDI. Receipt of chemotherapy, gastro-intestinal/abdominal surgery, PPI therapy, and antibiotic exposure contribute to infection risk. More effective CDI therapy for cancer patients is required and dedicated antibiotic stewardship programs in high-risk cancer populations are needed to ameliorate infection risk.
PURPOSE:Clostridium difficileinfection (CDI) is the leading cause of diarrhoea in hospitalised patients. Cancer populations are at high-risk for infection, but comprehensive evaluation in the current era of cancer care has not been performed. The objective of this study was to describe characteristics, risk factors, and outcomes of CDI in cancerpatients. METHODS: Fifty consecutive patients with CDI at a large Australian cancer centre (2013-2015) were identified from the hospital pathology database. Each case was matched by ward and hospital admission date to three controls without toxigenic CDI. Treatment and outcomes of infection were evaluated and potential risk factors were analysed using conditional logistic regression. RESULTS:Patients with CDI had a mean age of 59.7 years and 74% had an underlying solid tumour. Healthcare-associated infection comprised 80% of cases. Recurrence occurred in 10, and 12% of cases were admitted to ICU within 30 days. Severe or severe-complicated infection was observed in 32%. Independent risk factors for infection included chemotherapy (odds ratio (OR) 3.82, 95% CI 1.67-8.75; p = 0.002), gastro-intestinal/abdominal surgery (OR 4.64, 95% CI 1.20-17.91; p = 0.03), proton pump inhibitor (PPI) therapy (OR 2.47, 95% CI 1.05-5.80; p = 0.04), and days of antibiotic therapy (OR 1.04, 95% CI 1.01-1.08; p = 0.02). CONCLUSIONS: Severe or complicated infections are frequent in patients with cancer who develop CDI. Receipt of chemotherapy, gastro-intestinal/abdominal surgery, PPI therapy, and antibiotic exposure contribute to infection risk. More effective CDI therapy for cancerpatients is required and dedicated antibiotic stewardship programs in high-risk cancer populations are needed to ameliorate infection risk.
Authors: Young Kyung Yoon; Min Ja Kim; Jang Wook Sohn; Hye Suk Kim; Yoon Ji Choi; Jung Sun Kim; Seung Tae Kim; Kyong Hwa Park; Seok Jin Kim; Byung Soo Kim; Sang Won Shin; Yeul Hong Kim; Yong Park Journal: Support Care Cancer Date: 2014-03-05 Impact factor: 3.603
Authors: Tamar F Barlam; Sara E Cosgrove; Lilian M Abbo; Conan MacDougall; Audrey N Schuetz; Edward J Septimus; Arjun Srinivasan; Timothy H Dellit; Yngve T Falck-Ytter; Neil O Fishman; Cindy W Hamilton; Timothy C Jenkins; Pamela A Lipsett; Preeti N Malani; Larissa S May; Gregory J Moran; Melinda M Neuhauser; Jason G Newland; Christopher A Ohl; Matthew H Samore; Susan K Seo; Kavita K Trivedi Journal: Clin Infect Dis Date: 2016-04-13 Impact factor: 9.079
Authors: Zaid M Abdelsattar; Greta Krapohl; Layan Alrahmani; Mousumi Banerjee; Robert W Krell; Sandra L Wong; Darrell A Campbell; David M Aronoff; Samantha Hendren Journal: Infect Control Hosp Epidemiol Date: 2015-01 Impact factor: 3.254
Authors: Oliver A Cornely; Mark A Miller; Bruno Fantin; Kathleen Mullane; Yin Kean; Sherwood Gorbach Journal: J Clin Oncol Date: 2013-05-28 Impact factor: 44.544
Authors: Claudia Slimings; Paul Armstrong; Wendy D Beckingham; Ann L Bull; Lisa Hall; Karina J Kennedy; John Marquess; Rebecca McCann; Andrea Menzies; Brett G Mitchell; Michael J Richards; Paul C Smollen; Lauren Tracey; Irene J Wilkinson; Fiona L Wilson; Leon J Worth; Thomas V Riley Journal: Med J Aust Date: 2014-03-17 Impact factor: 7.738
Authors: Anca Trifan; Carol Stanciu; Irina Girleanu; Oana Cristina Stoica; Ana Maria Singeap; Roxana Maxim; Stefan Andrei Chiriac; Alin Ciobica; Lucian Boiculese Journal: World J Gastroenterol Date: 2017-09-21 Impact factor: 5.742