Carolyn D Alonso1,2, David A Braun3, Ishan Patel4, Mona Akbari5, Daniel Jungmyung Oh6, Tomi Jun7, Malgorzata McMasters8, Sarah P Hammond2,9, Brett Glotzbecker10, Corey Cutler10, Daniel A Leffler5, Karen K Ballen11, Ciarán P Kelly2,5. 1. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA. 2. Harvard Medical School, Boston, MA, USA. 3. Dana-Farber/Partners CancerCare Program, Boston, MA, USA. 4. Department of Medicine, Icahn School of Medicine, Elmhurst Program, New York, NY, USA. 5. Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 6. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 7. Stanford Health Care, Stanford, CA, USA. 8. Section of Hematological Malignancies and Bone Marrow Transplantation, Beth Israel Deaconess Medical Center, Boston, MA, USA. 9. Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. 10. Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA. 11. Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
Abstract
BACKGROUND: Clostridium difficile infection (CDI) is the leading cause of health-care associated infectious diarrhea. The aim of this study was to evaluate the epidemiology and risk factors for CDI in the 100 days following umbilical cord blood transplantation (UCBT) at three Boston hospitals. METHODS: We performed a multicenter, retrospective, case-cohort study of 226 UCBT recipients at Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Dana Farber/Brigham and Women's Cancer Center from 2003 to 2012. CDI was defined as diarrhea (≥3 unformed bowel movements for at least 2 days) plus a positive stool test for toxinogenic C. difficile and not attributed to any other cause. RESULTS: Among 226 UCBT recipients, 22 patients (9.7%) developed CDI within the first 100 days of transplant (corresponding to an infection rate of 10.8 cases per 10 000 person-days). The 100-day and 1-year rates were stable across the time period and between institutions. UCBT recipients with CDI were more likely than non-CDI patients to be older, with higher body mass indices, and to have received an antipseudomonal penicillin agent. In a time-dependent case-cohort analysis of the risk factors associated with CDI in the first 100 days after UCBT, bacterial infection after UCBT was the strongest risk factor for CDI (hazard ratio 2.8; 95% confidence interval 1.08-7.24; P=.03), after adjustment for transplant variables including antibiotic exposure. CONCLUSION: This study verifies the previously reported risk factors for CDI including older age and antibiotic exposure and identifies a novel association between bacterial infections and risk for CDI.
BACKGROUND:Clostridium difficileinfection (CDI) is the leading cause of health-care associated infectious diarrhea. The aim of this study was to evaluate the epidemiology and risk factors for CDI in the 100 days following umbilical cord blood transplantation (UCBT) at three Boston hospitals. METHODS: We performed a multicenter, retrospective, case-cohort study of 226 UCBT recipients at Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Dana Farber/Brigham and Women's Cancer Center from 2003 to 2012. CDI was defined as diarrhea (≥3 unformed bowel movements for at least 2 days) plus a positive stool test for toxinogenic C. difficile and not attributed to any other cause. RESULTS: Among 226 UCBT recipients, 22 patients (9.7%) developed CDI within the first 100 days of transplant (corresponding to an infection rate of 10.8 cases per 10 000 person-days). The 100-day and 1-year rates were stable across the time period and between institutions. UCBT recipients with CDI were more likely than non-CDI patients to be older, with higher body mass indices, and to have received an antipseudomonal penicillin agent. In a time-dependent case-cohort analysis of the risk factors associated with CDI in the first 100 days after UCBT, bacterial infection after UCBT was the strongest risk factor for CDI (hazard ratio 2.8; 95% confidence interval 1.08-7.24; P=.03), after adjustment for transplant variables including antibiotic exposure. CONCLUSION: This study verifies the previously reported risk factors for CDI including older age and antibiotic exposure and identifies a novel association between bacterial infections and risk for CDI.