Poorer outcomes among cancer patients diagnosed with Clostridium difficile infections in United States community hospitals

Delgado, Andrew; Reveles, Ivan Alexander; Cabello, Felicia T.; Reveles, Kelly R.

doi:10.1186/s12879-017-2553-z

Cited by 44 publications

(45 citation statements)

References 40 publications

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“…Because CDIs are associated with increased mortality and hospital LOS among cancer patients, guideline-recommended risk stratification represents a vital option that could mitigate the unnecessary risks associated with hospitalization. 20 Hospitalizations for FN patients are associated with significant healthcare costs and adverse events. 4,15,16,21 Due to rising healthcare costs, it is vital to utilize validated methods to eliminate the unnecessary costs to the patient and healthcare system.…”

Section: Discussionmentioning

confidence: 99%

Guideline adherence for the management of emergency department patients with febrile neutropenia and no infection source: Is there room for improvement?

Jansma

Vakkalanka

Talan

et al. 2020

J Oncol Pharm Pract

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Introduction Febrile neutropenia is an oncologic emergency associated with significant morbidity and mortality. The objective of our study was to assess guideline adherence and clinical outcomes associated with the management of high- and low-risk febrile neutropenia patients presenting to the emergency department. Methods A retrospective observational cohort study was conducted at a 60,000-visit emergency department at an academically-affiliated tertiary referral hospital. Patients were identified as low- or high-risk using the guideline-recommended Multinational Association for Supportive Care in Cancer score. The primary outcome was the proportion of cases in which the management was concordant with applicable febrile neutropenia guidelines. Guideline adherence was defined as hospital admission and intravenous antimicrobial therapy for high-risk patients and discharge home with oral antimicrobial therapy for low-risk patients. Secondary outcomes included appropriate vancomycin administration, hospital length of stay, rates of acute kidney injury, in-hospital Clostridium difficile infection rates, and 30-day mortality. Results Of the 237 patients included, 94 (39.7%) were low-risk patients and 143 (60.3%) were high-risk patients. Guideline adherence occurred in 96.8% of high-risk patients and 0.4% of low-risk patients. Mean hospital length of stay of the low-risk group was 5 ± 5.0 days compared to 7.2 ± 7.3 days in the high-risk group. Vancomycin was often inappropriately given in 69.5% of high-risk patients. Clostridium difficile occurred in 15 (10.3%) adherent and 4 (4.4%) non-adherent patients. By 30 days, 4 (4.3%) low-risk and 15 (10.7%) high-risk patients died. Conclusion Adherence to the febrile neutropenia guidelines was low resulting in unnecessary hospital admissions of low-risk patients and frequent over-prescription of empirical vancomycin.

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Section: Discussionmentioning

confidence: 99%

Guideline adherence for the management of emergency department patients with febrile neutropenia and no infection source: Is there room for improvement?

Jansma

Vakkalanka

Talan

et al. 2020

J Oncol Pharm Pract

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“…It is thought that C. difficile develops in part because of the disturbance of the normal gut microbiome, specifically from antibiotics [ 1 ]. Cancer patients have multiple risk factors as well, including prolonged and/or recurrent hospitalizations, immunosuppression, and therapies that can alter the microbiome [ 13 ]. There is also a paucity of data showing the effects of radiation therapy on the predisposition to CDI [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…During his hospitalization, this patient received ceftriaxone, one of the more common antibiotics that predispose patients to CDIs [ 1 ]. He was hospitalized for over a week, was on immunotherapy, and received radiation treatments to the rectum, increasing his risk of contracting C. difficile [ 13 , 14 ]. Regarding how he developed bacteremia from C. difficile , it is possible that the radiotherapy facilitated translocation of the bacteria into the bloodstream.…”

Section: Discussionmentioning

confidence: 99%

Seeing C. diff Differently: A Case of Clostridioides difficile Bacteremia in Metastatic Melanoma

Vasser

Ayisire

2020

Am J Case Rep

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Patient: Male, 51-year-old Final Diagnosis: Atrial mass • Clostridioides difficile bacteremia • hemodynamic shock • metastatic melanoma Symptoms: Ascites • atrial flutter • edema • mass in abdomen • tachycardia Medication: — Clinical Procedure: Paracentesis • radiation therapy Specialty: Cardiology • Infectious Diseases • General and Internal Medicine • Oncology Objective: Rare disease Background: Clostridioides difficile infection (CDI) is a common community-acquired and nosocomial infection that usually presents as colitis. C. difficile bacteremia (CDB) is a rare blood infection, with only a few cases recorded in the literature. We seek to expound on the current literature by detailing the clinical course of a patient with metastatic melanoma who developed CDB. Case Report: This case highlights the hospital course of a 51-year-old man admitted for a new onset of arrhythmia during the evaluation and management of a malignancy. The patient experienced hemodynamic collapse and rapid deterioration, which progressed to death. The etiology of death is thought to be septic shock due to CDB in the setting of multiple comorbidities. Conclusions: The patient was predisposed to CDI because of the disruption of his intestinal milieu by the administration of a cephalosporin for the treatment of his suspected secondary bacterial peritonitis. His treatment with palliative radiation to his rectal mass placed him further at risk of CDI. We believe either of these could have contributed alone or synergistically to the development of his CDB.

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“…C. difficile , previously Clostridium difficile , is a gram-positive anaerobe that colonizes the bowel after antibiotic administration alters the normal gut flora. It is the most common cause of healthcare-associated infections, and cancer patients are twice more likely than other inpatients to develop hospital-onset C. difficile infection [ 42 ]. Patients usually develop C. difficile colitis a few weeks after antibiotic administration, and 10–25% of patients develop recurrent C. difficile infection [ 43 ].…”

Section: Role Of Imaging In the Cancer Patient Infectionsmentioning

confidence: 99%

Imaging of abdominal and pelvic infections in the cancer patient

et al. 2021

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Poorer outcomes among cancer patients diagnosed with Clostridium difficile infections in United States community hospitals

Cited by 44 publications

References 40 publications

Guideline adherence for the management of emergency department patients with febrile neutropenia and no infection source: Is there room for improvement?

Guideline adherence for the management of emergency department patients with febrile neutropenia and no infection source: Is there room for improvement?

Seeing C. diff Differently: A Case of Clostridioides difficile Bacteremia in Metastatic Melanoma

Imaging of abdominal and pelvic infections in the cancer patient

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