Clostridium difficile infection in hospitalized cancer patients in Beijing, China is facilitated by receipt of cancer chemotherapy

Han, Xueyan; Du, Chunyang; Zhang, C. L.; Zheng, Chao; Wang, L.; Li, D.; Yu, Feng; DuPont, Herbert L.; Jiang, Zhi‐Dong; Shi, Yuankai

doi:10.1016/j.anaerobe.2013.05.004

Cited by 19 publications

(15 citation statements)

References 22 publications

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“…In a previous study, we found that cancer patients younger than 50 years were more likely to be C. difficile carriers (18). Similar results from a study of CDI in hospitalized cancer patients in Beijing, China, revealed that the mean age of cancer patients with CDI was 56 Ϯ 16 years, which is significantly lower than the mean age reported in non-cancer hospitals in the United States (4,21). Similarly, results of a study on factors associated with Staphylococcus aureus nasal carriage among healthy people in northern China indicated that younger people (Յ24 years old) were more prone to S. aureus nasal carriage (22).…”

Section: Discussionmentioning

confidence: 48%

Molecular Epidemiology of Clostridium difficile Infection in Hospitalized Patients in Eastern China

et al. 2017

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Few studies on risk factors for and transmission of Clostridium difficile infection (CDI) in China have been reported. A cross-sectional study was conducted for 3 years in eastern China. Consecutive stool specimens from hospitalized patients with diarrhea were cultured for C. difficile. C. difficile isolates from these patients then were analyzed for toxin genes, genotypes, and antimicrobial resistance. A severity score for the CDI in each patient was determined by a blinded review of the medical record, and these scores ranged from 1 to 6. A total of 397 out of 3,953 patients (10.0%) with diarrhea were found to have CDI. Severity of CDI was mild to moderate, and the average (Ϯ standard deviation) severity score was 2.61 Ϯ 1.01. C. difficile was isolated from stool specimens in 432 (10.9%) of all the patients who had diarrhea. C. difficile genotypes were determined by multilocus sequence analysis and PCR ribotyping; sequence type 37 (ST37)/ribotype 017 (RT017) (n ϭ 68, 16.5%) was the dominant genotype. Eleven patients (16.2%) with this genotype had a CDI severity score of 5. Overall, three RTs and four STs were predominant; these genotypes were associated with significantly different antimicrobial resistance patterns in comparison to all genotypes ( 2 ϭ 79.56 to 97.76; P Ͻ 0.001). Independent risk factors associated with CDI included age greater than 55 years (odds ratio . CDI is clearly a problem in eastern China and has a prevalence of 10.0% in hospitalized patients. Among risk factors for CDI, the advanced age threshold was younger for Chinese patients than that reported for patients in developed countries.[

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Section: Discussionmentioning

confidence: 48%

Molecular Epidemiology of Clostridium difficile Infection in Hospitalized Patients in Eastern China

et al. 2017

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“…These findings can be explained by the poorer underlying conditions and reduced immune functions of these potential CDI patients because C. difficile is an opportunistic pathogen. Furthermore, some authors have concluded that exposure to gastric acid suppressants, chemotherapy, immunosuppressive drugs, and nasogastric feeding may increase the risk of CDI [22][23][24]. Other studies have described the connection between the acquisition of CDI and the length of patients' hospital stays and have come to divergent conclusions [16,23,25].…”

Section: Discussionmentioning

confidence: 96%

Clinical characterization and risk factors of Clostridium difficile infection in elderly patients in a Chinese hospital

Zhang

Dong

Jiang

et al. 2015

J Infect Dev Ctries

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Introduction: Clostridium difficile is a common cause of nosocomial diarrhea, especially in elderly patients. This study aimed to analyze the clinical features and assess the risk factors associated with Clostridium difficile infection (CDI) in elderly hospitalized patients. Methodology: A retrospective case-control study was conducted among elderly hospitalized patients (> 60 years of age) in a Chinese tertiary hospital between 2010 and 2013. Fifty-two CDI patients and 150 randomly selected non-CDI patients were included in the study. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests. Logistic regression analyses were performed on a series of factors to determine the risk factors for CDI among the elderly hospitalized patients. Results: The elderly CDI patients showed higher leukocyte counts, lower serum albumin levels, longer duration of hospital stay, and higher mortality compared to the non-CDI patients. The proportion of patients admitted to the intensive care unit or exposed to gastric acid suppressants was also significantly different (p < 0.05) between the two groups. Multivariate analysis indicated that serum creatinine (OR 1.004; 95% CI 1.001-1.008), surgical intervention (OR 6.132; 95% CI 2.594-14.493), the number of comorbidities (OR 2.573; 95% CI 1.353-4.892), gastrointestinal disease (OR 4.670; 95% CI 2.002-10.895), and antibiotic use (OR 6.718; 95% CI 2.846-15.859) were independently associated with CDI. Conclusions: This study revealed several risk factors for CDI among elderly hospitalized patients. These findings will increase the knowledge concerning this disease and provide information regarding the control and prevention of CDI in the elderly.

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“…An interesting study from China has shown that Clostridium difficile diarrhea is far more common in hospitalized patients with cancer receiving chemotherapy compared with those who do not receive chemotherapy [37]. This indicates the need for proper attention to other potential contributing factors when evaluating and treating diarrhea in patients with cancer receiving systemic therapy.…”

Section: Discussionmentioning

confidence: 98%

Risk of selected gastrointestinal toxicities in cancer patients treated with MEK inhibitors: a comparative systematic review and meta-analysis

Abdel‐Rahman

Elhalawani

Ahmed

et al. 2015

Expert Review of Gastroenterology & Hepatology

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We performed a systematic review and meta-analysis of the risk of gastrointestinal (GI) toxicities associated with MEK inhibitors. Eligible studies included randomized Phase II and III trials of cancer patients on the three MEK inhibitors (trametinib, selumetinib and cobimetinib), describing events of stomatitis, diarrhea and vomiting. Our search strategy yielded 250 potentially relevant citations from Pubmed/Medline, Google scholar and CENTRAL Cochrane registry. After exclusion of ineligible studies, a total of 16 clinical trials were considered eligible for the meta-analysis. The relative risks of all-grade stomatitis, diarrhea and vomiting were 2.03 (95% CI 1.41-2.96; p = 0.002), 1.92 (95% CI 1.48-2.50; p < 0.00001) and 1.35 (95% CI 1.06-1.71; p = 0.01). Subgroup analyses according to agent used (trametinib vs Selumetinib), the regimen used (monotherapy vs combination) and the cancer treated (melanoma vs nonmelanoma) did not reveal any significant difference between the subgroups. Our meta-analysis has demonstrated that MEK inhibitor-based treatment is associated with an increased risk of stomatitis, diarrhea and vomiting compared to control. Clinicians should be aware of this risk and perform regular assessment.

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Clostridium difficile infection in hospitalized cancer patients in Beijing, China is facilitated by receipt of cancer chemotherapy

Cited by 19 publications

References 22 publications

Molecular Epidemiology of Clostridium difficile Infection in Hospitalized Patients in Eastern China

Molecular Epidemiology of Clostridium difficile Infection in Hospitalized Patients in Eastern China

Clinical characterization and risk factors of Clostridium difficile infection in elderly patients in a Chinese hospital

Risk of selected gastrointestinal toxicities in cancer patients treated with MEK inhibitors: a comparative systematic review and meta-analysis

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