Risk Factors Associated with Severe Clostridioides difficile Infection in Patients with Cancer

Abstract

Introduction: Antibiotic use is a risk factor for Clostridioides difficile infection (CDI). Few studies have correlated use of prior antibiotic classes with CDI, microbiome composition, and disease severity in patients with cancer. We hypothesized that previous antibiotic exposure and fecal microbiome composition at time of presentation are risk factors for severe CDI in patients with cancer.Methods: This non-interventional, prospective, cohort study examined 200 patients with cancer who had their first episode or first recurrence of CDI. C. difficile was identified using nucleic acid amplification testing. Univariate analysis was used to determine significant risk factors for severe CDI. Fecal microbiome composition was determined by sequencing the V3/V4 region of 16 s rDNA encoding gene. Differential abundance analyses were used to single out significant microbial features which differed across severity levels.

The Impact of the COVID-19 Pandemic on Clostridioides Difficile Infection Outcomes and Disparities in Care in New York City

“…However, this would still not explain why this cohort did not experience increased mortality. Another possible explanation is that empiric antibiotic use was common among COVID patients, especially at the beginning of the pandemic, and antibiotic use has been associated with more severe infection in certain populations [24,46,47]. There was a trend suggesting patients with concomitant COVID and CDI were exposed to more antibiotics in the 3 months prior to admission, but it did not reach signi cance (68.0% no COVID vs. 92.3% concomitant COVID, p-value 0.06, Online Resource 3).…”

Prevention and treatment of C. difficile in cancer patients

“…Certain antibiotics, such as clindamycin, fluoroquinolones, cephalosporins, and carbapenems, have been particularly associated with a higher risk of CDI [8,11 ▪ ,14,28]. However, any antibiotic, especially those with anaerobic activity, can disrupt the gut microbiota and thereby increase the risk of CDI [29 ▪▪ ].…”

“…Additionally, factors specific to cancer, such as mucositis, chemotherapy, and other immunosuppressive therapies are not considered. Finally, the impact of neutropenia on CDI severity and outcomes remains controversial [29 ▪▪ ,38]. Neutropenia can limit macrophage phagocytosis and has been associated with increased mortality due to mucosal injury and bloodstream infection in animal models [24].…”

“…Most studies involving cancer patients have reported low rates of severe or fatal cases of CDI [12,29 ▪▪ ,41,42]. For instance, a recent study in patients with acute myeloid leukaemia (AML) found no differences in various clinical parameters, such as length of stay, need for ICU admission, development of acute renal failure, chemotherapy response, or mortality, between patients with or without CDI [11 ▪ ].…”

“…A recent study also conducted at the MDACC assessed CDI severity in cancer patients regarding microbiota composition, alpha, and beta diversity [29 ▪▪ ]. Briefly, alpha diversity refers to the diversity of microorganisms within a specific sample or individual, while beta diversity compares the differences in microbial composition between different individuals or groups.…”