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Prognosis of Clostridium difficile infection in adult oncohaematological patients: experience from a large prospective observational study

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Abstract

The aim of the study is to evaluate demographics, epidemiology, clinical characteristics, treatment and outcomes of Clostridium difficile infection (CDI) in patients with and without concurrent cancer. This is a prospective cohort study of consecutive primary CDI episodes in adults (January 2006–December 2016). CDI was diagnosed on the presence of diarrhoea and positive stool testing for toxigenic C. difficile. Univariate analysis assessed differences between cancer and non-cancer patients. Risk factors of all-cause 30-day mortality were determinate using the logistic multivariable procedure. In total, 787 CDI episodes were recorded, 191 in cancer patients (median age 64, IQR 50–73). Of these, 120 (63%) had solid and 71 (37%) haematological malignancies (24 received a stem cell transplant). At the CDI diagnosis, 158 (82.7%) cancer patients had prior antibiotics and 150 (78.5%) were receiving proton pump inhibitors. Fifty-seven (80.3%) patients with haematological and 52 (43.3%) with solid malignancies were under chemotherapy at diagnosis; 25 (35.2%) with haematological and 11 (9.2%) with solid malignancies had an absolute neutrophil count < 1000/mm3. Overall, 30-day mortality was higher in cancer patients than in those without (19.2 vs. 8.6% respectively, p < 0.001); recurrence rates did not vary significantly (11.1 vs. 11%, p = 0.936). By type of neoplasm, 30-day mortality was higher in patients with haematological malignancies and solid tumours than in patients without cancer (respectively, 25.4 vs. 8.6%; p < 0.001 and 15 vs. 8.6%; p < 0.001). Our results suggest that the prognosis of CDI (30-day mortality) is poorer in patients with cancer than in those without although percentages of recurrent infection are similar in these two patient populations.

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Acknowledgments

We thank Celine Cavallo for English language support and Mario Martin Castillo for biostatistical support.

Funding

This work was supported by the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III, cofinanced by the European Development Regional Fund (ERDF) “A way to achieve Europe”, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003). PB was supported by the Instituto de Salud Carlos III FIS16/01433 and announcement PERIS 2017 from Generalitat de Catalunya.

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Author notes

  1. Isabel Ruiz-Camps and Benito Almirante contributed equally to this work.

Authors and Affiliations

  1. Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Medicine Department, Universitat Autònoma de Barcelona, Pg. Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Thais Larrainzar-Coghen, Dolors Rodríguez-Pardo, Juan Aguilar-Company, Carmen Ferrer, Isabel Ruiz-Camps & Benito Almirante

  2. Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain

    Dolors Rodríguez-Pardo, Virginia Rodríguez, Gloria Roig, Carmen Ferrer, Isabel Ruiz-Camps & Benito Almirante

  3. Haematology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Pere Barba

  4. Medical Oncology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Juan Aguilar-Company

  5. Microbiology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Virginia Rodríguez & Gloria Roig

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  1. Thais Larrainzar-Coghen
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Correspondence to Dolors Rodríguez-Pardo.

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Larrainzar-Coghen, T., Rodríguez-Pardo, D., Barba, P. et al. Prognosis of Clostridium difficile infection in adult oncohaematological patients: experience from a large prospective observational study. Eur J Clin Microbiol Infect Dis 37, 2075–2082 (2018). https://doi.org/10.1007/s10096-018-3341-4

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