Clostridium difficileInfection in Patients with Neutropenia

Abstract

Clostridium difficile is the most important cause of nosocomial infectious diarrhea. The importance of C. difficile-associated diarrhea (CDAD) has been poorly investigated in patients with neutropenia who have hematologic malignancies. A retrospective chart review of all patients treated in the leukemia ward of a university medical center during 1991-2000 determined that 875 courses of myelosuppressive chemotherapy were administered. CDAD occurred in 7.0% of all cycles. In 8.2% of the patients, severe enterocolitis developed. Two patients died while they had diarrhea. However, in no patient was C. difficile infection clinically considered to be the primary cause of death. The response rate to oral metronidazole was 90.9%. These data indicate that C. difficile infection is not rare and should be suspected whenever a hospitalized patient with neutropenia develops diarrhea. Oral metronidazole can be recommended as initial drug of choice for treatment of patients with neutropenia who have hematologic malignancies and CDAD.

Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm?

“…The authors found that CDAD was the second most common infectious complication occurring in this cohort. Gorschlu¨ter et al 26 analyzed their data on 875 courses of myelosuppressive therapy in 371 patients with hematologic malignancies and reported a 7% incidence of CDAD (61 episodes in 53 patients). Diarrhea was defined as at least two loose stools per day.…”

Severity of Clostridium difficile–Associated Disease (CDAD) in Allogeneic Stem Cell Transplant Recipients: Evaluation of a CDAD Severity Grading System

“…However, studies of CDAD in hematopoietic cell transplantation patients disagree about the incidence of, severity of, and risk factors for CDAD. [2][3][4][5][6][7][8][9][10] A lack of differentiation between mild cases and severe cases of CDAD may explain some of these discrepancies. To address this deficiency and to further study CDAD outcomes among allogeneic stem cell transplant recipients, we developed and validated a grading system for CDAD severity using a modified version of the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE) and based on the presenting clinical CDAD symptoms.…”

Peri‐transplant clostridium difficile infections in patients undergoing allogeneic hematopoietic progenitor cell transplant

“…A study found that gastrointestinal colonization with toxigenic Clostridium difficile occurred in 12% of recipients of HPC transplant on admission to the hospital [6]. In addition, these patients are immunocompromised, receive extensive exposure to broad spectrum antimicrobials before and after HPC transplant, have compromise of the integrity of the intestinal mucosa due to the high dose chemoradiation given to the patients as part of transplant preparative regimens, and also often have very prolonged hospital stay [7][8][9]. Studies have shown the association of CDI with the development of acute Graft-versus-host disease (GVHD) [10,11] and increased non-relapse mortality [10] after allogeneic HPC transplant.…”