Clostridioides difficile colonization and infection in patients admitted for a first autologous transplantation: Incidence, risk factors, and patient outcomes

Abstract

Background More data are needed regarding the incidence, risk factors, and outcomes for Clostridioides difficile infection (CDI) and colonization in patients undergoing an autologous hematopoietic stem cell transplantation (AHSCT). Methods We studied 472 consecutive patients admitted for a first AHSCT and conducted a prospective C difficile stool surveillance and ribotyping analysis in a subset of 94 patients. Results Clostridioides difficile infection was diagnosed in 7% of patients for an incidence of 3.4 CDI/1000 inpatient days, recurrent/reinfection CDI was rare. CDI was increased in patients who were colonized on admission, had required a recent pre‐admission inpatient stay for fever and/or serious infection, or received empiric therapy with a carbapenem or extended‐spectrum penicillin. CDI was associated with a longer length of stay and higher hospital costs. Twelve of 94 patients (13%) were found to have colonization on admission; CDI was diagnosed in 27% of these vs 1% in those with initial negative stools. Colonization in the hospital for those negative on admission was infrequent. C difficile ribotyping showed a predominance of 014/020. Conclusions Clostridioides difficile infection is a significant infection in patients receiving a first AHSCT. The risk factors identified may be useful in designing preventive interventions.

Risk Factors and Outcome of C. difficile Infection after Hematopoietic Stem Cell Transplantation

“…Another controversial point is the link between GVHD and CDI. In our analysis, the frequency of CDI was similar in patients with or without acute GVHD, as reported by other authors [15,19]. However, other studies [6,9,16] observed that CD was a significant risk factor for acute GVHD development, in particular for the cases involving the gastro-intestinal system, suggesting that gut dysbiosis and disruption of mucosal barriers might promote CDI as well as GVHD.…”

“…In our study the main risk factors for CDI development were antibiotic therapy before HSCT, previous abdominal surgery, HCV infection, and other bacterial and fungal infections identified before or concomitantly with CDI during hospitalization for HSCT. Therefore, the use of antibiotics before and during HSCT hospitalization remains the leading risk factor in our analysis as well as in previous studies [6,7,15]. Broad spectrum antibiotics, such as cephalosporines, penicillines and fluoroquinolones, are associated with gut dysbiosis, development of bacterial resistance, malabsorption and alteration of the gut-liver axis [3].…”

“…Patients who undergo hematopoietic stem cell transplants (HSCT) are at a more major risk of CDI than other subjects, due to prolonged hospitalization, multiple infections with massive usage of antibiotic therapy [3], alteration of the intestinal mucosa caused by chemotherapy during conditioning regimens, and immunosuppressive treatment [4,5]. The role of CDI during HSCT remains unclear due to studies with heterogeneous patient cohorts and conflicting results [6][7][8][9][10][11][12][13][14][15][16] (Table 1). The risk for CDI among these patients is reported to be frequently higher than in the general population [9,16].…”

Early Clostridioides difficile infection characterizations, risks, and outcomes in allogeneic hematopoietic stem cell and solid organ transplant recipients

“…40 In allo-HCT recipients with CDI, the LOS is longer leading to higher hospital costs. 41 In this study, the median LOS was 6 days longer for allo-HCT with CDI compared to controls, and 9.5 days longer for SOT with CDI compared to controls. We observed frequent fever (35% of allo-HCT with CDI) like other reports, 42 which was less frequent after SOT with CDI.…”