Risk factors, preemptive therapy, and antiperistaltic agents for <i><scp>C</scp>lostridium difficile</i> infection in cancer patients

Krishna, Somashekar G.; Zhao, Wei‐Li; Apewokin, Senu; Krishna, Kavya; Chepyala, Pavan; Anaissie, Elias

doi:10.1111/tid.12112

Cited by 17 publications

(10 citation statements)

References 40 publications

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“…Thus, it is possible that both IgG and IgA anti-toxin responses play a role in controlling disease after C. difficile challenge. The protective role of humoral immunity in humans may also be supported by incidental findings in a study assessing the use of anti-peristaltic agents in C. difficile infection in cancer patients [33]. In this study 303 Multiple Myeloma patients received chemotherapy and 43 developed C. difficile associated diarrhea.…”

Section: Lymphocytesmentioning

confidence: 58%

“…In this study 303 Multiple Myeloma patients received chemotherapy and 43 developed C. difficile associated diarrhea. Out of all Immunoglobulin Myeloma isotypes, IgA Multiple Myeloma seems to have a protective effect against C. difficile diarrhea (RR 0.35; 95% CI 0.13–0.93, p 0.04) [33]. The mechanism of protection is not clear but is likely that hyper-secretion of mucosal IgA prevents C. difficile infection.…”

Section: Lymphocytesmentioning

confidence: 99%

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Role of the leukocyte response in normal and immunocompromised host after Clostridium difficile infection

2017

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Clostridium difficile is the leading cause of healthcare-associated infections in the United States. Clinically, C. difficile-associated disease can present as asymptomatic colonization, self-limited diarrheal illness or severe colitis (that may result in death). This variability in disease course and outcomes suggests that host factors play an important role as key determinants of disease severity. Currently, there are several scoring indices to estimate severity of C. difficile-associated disease. Leukocytosis and renal failure are considered to be the most important predictors of C. difficile disease severity in hosts with a normal immune system. The degree of leukocytosis which is considered significant for severe disease and how it is scored vary amongst scoring indices. None of the scores have been prospectively validated, and while total WBC count is useful to estimate the magnitude of the host response in most patient populations, in immune-compromised patients like those receiving chemotherapy, solid organ transplant patients or hematopoietic stem cell transplants the WBC response can be variable or even absent making this marker of severity difficult to interpret. Other cellular subsets like neutrophils, eosinophils and lymphocytes provide important information about the host immune status and play an important role in the immune response against C. difficile infection. However, under the current scoring systems the role of these cellular subsets have been underestimated and only total white blood cell counts are taken into account. In this review we highlight the role of host leukocyte response to C. difficile challenge in the normal and immunocompromised host, and propose possible ways that would allow for a better representation of the different immune cell subsets (neutrophils, lymphocytes and eosinophils) in the current scoring indices.

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Section: Lymphocytesmentioning

confidence: 58%

Section: Lymphocytesmentioning

confidence: 99%

Role of the leukocyte response in normal and immunocompromised host after Clostridium difficile infection

2017

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“…Fontos, hogy nem találtak összefüggést a CD-infekció és egy adott kemoterápiás szer/protokoll között [65]. Ugyanakkor, úgy tűnik, hogy az IgA-myeloma protektív hatású a CD-infekció szempontjából [66].…”

Section: Megbeszélésunclassified

A Clostridium difficile onkológiai vonatkozásai

Telekes

2016

Orvosi Hetilap

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A Clostridium difficile az egyik leggyakoribb fertőzés a daganatos betegek között. Diagnózisát nehezíti, hogy a fertőzés tünetei és az onkológiai kezelések mellékhatásai hasonlóak lehetnek. Maga a kemoterápia is elősegítheti a Clostridium difficile-infekció kialakulását. Bár számos kockázati faktor ismert, ezek hiányában is kialakulhat a fertő-zés. A fatális Clostridium difficile-infekció kockázati faktora a neutropenia, ami egyben a kemoterápia mellékhatása is. Ezért, ha daganatos betegek esetén a potenciális infekció tünetei megjelennek (például diarrhoea naponta több mint háromszor, 38,5 °C-ot meghaladó láz, colitis, szérumkreatinin-szint gyors emelkedése) a Clostridium difficile-fertő-zést ki kell zárni. Amennyiben a fertőzés igazolódik, azt a leghatékonyabb módon kezelni kell. Orv. Hetil., 2016, 157(28), 1110-1116. Kulcsszavak: Clostridium difficile, onkológia, fidaxomicin Oncologic aspects of Clostridium difficileClostridium difficile infection is one of the most frequent among cancer patients. Its diagnosis is complicated by the fact that the symptoms of the infection and the side effects of the anticancer treatments could be similar. Chemotherapy itself might facilitate Clostridium difficile infection. Several risk factors are known but Clostridium difficile infection can develop in the absence of these. Neutreopenia is a risk factor for fatal Clostridium difficile infection and also the side effect of chemotherapy. Therefore, if symptoms of the potential infection develop (eg. diarrhoea more than three times a day, fever above 38.5 o C, colitis, rapid increase of serum creatinin) Clostridium difficile infection should be excluded. If the infection is confirmed it should be managed in the most efficient way. Rövidítések CD = Clostridium difficile; CDAD = Clostridium difficile-aszszociált diarrhoea; EIA = enzimimmunoassay; PCR = polimeráz láncreakció; TcdA = Clostridium difficile toxin A; TcdB = Clostridium difficile toxin B Keywords: Clostridium difficile, oncology, fidaxomicin A Clostridium difficileA Clostridium difficile (CD) az ember normális bélflórá-jának része. Azonos családba tartozik, mint a patogén Clostridium tetani (ami a tetanust okozza) és a Clostridium botullinum (ami a botulizmust okozza). Mindenütt előfordul (levegő, víz, talaj, széklet, bármilyen felület), leggyakrabban WC-ülőkén, pelenkákon, padlón, telefonokon, körmökön, ékszereken, sztetoszkópon, háziálla-tokon, zöldségeken mutatták ki. A CD Gram-pozitív anaerob baktérium. A bélflórában lévő baktériumok egymás növekedését kordában tartják. Az aktív, infektív baktérium nem képes ellenállni a környezeti hatásoknak hosszú időn keresztül. Az inaktív forma, az úgynevezett spóra, azonban szabad levegőn, szennyeződésekben akár két évig is életképes. A spóra maga nem fertőző, de a bélbe jutva, belélegezve visszanyerheti infektív formáját. Antibiotikum-kezelést követően, amikor a bélflóra egyensúlya felborul, a CD-spórák a bélben aktív formává alakulnak és képesek gyorsan elszaporodni. Az aktív bak-

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“…Other risk factors include hypoalbuminemia, use of proton pump inhibitors, and antineoplastic therapy. [4][5][6][7][8][9][10][11] Diarrhea-related complications can include dehydration, electrolyte imbalances such as hypokalemia, hypomagnesemia, and hypotension. 10,12 The increased number of diarrhea days raise concern not only for increased nosocomial transmission in the inpatient setting but also for increased patient discomfort and physical deconditioning from reduced mobility.…”

mentioning

confidence: 99%

“…16 The 2017 guidelines omitted this recommendation, mentioning instead that the "addition of an antimotility agent such as loperamide as an adjunct to specific antimicrobial therapy for CDI may be safe, although no prospective or randomized studies are available." 17 Although some studies have suggested that there is no increase in the rate of adverse outcomes in patients with CDI who are treated with AAs, 11,18 there is a paucity of data on the safety of AA use because of clinical reluctance to use these agents in CDI. In response to these concerns, we conducted a retrospective cohort study of inpatients in the malignant hematology service to describe the use and outcomes of AAs in a population of patients with hematologic malignancies and concurrent CDI.…”

mentioning

confidence: 99%

Are Antimotility Agents Safe for Use in Clostridioides difficile Infections? Results From an Observational Study in Malignant Hematology Patients

Kuon

Wannier

Sterken

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objectives: To evaluate the safety of antimotility agents (AAs) in a population of patients with hematologic malignancies and concurrent Clostridioides difficile infection (CDI) and to describe the outcomes of AA use in a hospital setting. Patients and Methods: We used the electronic health record to identify patients who were hospitalized in the adult malignant hematology service who had 1 or more toxin-positive C difficile stool assay between April 1, 2012, and September 21, 2017. We reviewed medical charts to obtain information on the use of AAs and any subsequent gastrointestinal complications. Results: There were 339 patients who were stool toxin positive for CDI during the study period. Of those, 94 patients (27%) were prescribed AAs within 14 days of CDI diagnosis. All patients received CDI antimicrobial therapy within the first 24 hours. There were 2 adverse gastrointestinal events in the group that received AAs and 6 in the group that did not receive AAs. The risk of adverse events did not differ between patients who received AAs and those who did not (adjusted odds ratio, 0.36; 95% CI, 0.06 to 2.10). The mean age of the full cohort was 52.7AE15.5 years, and the mean length of stay was 26.7AE22.6 days. Early AA use (<48 hours of diagnosis) was not associated with increased adverse effects. Conclusion: There was no increase in the incidence of gastrointestinal events in the arm that used AAs compared with the control arm. The evidence suggests that for patients with hematologic malignancies and CDI, the addition of AAs to appropriate antimicrobial therapy poses no additional risk.

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Risk factors, preemptive therapy, and antiperistaltic agents for Clostridium difficile infection in cancer patients

Cited by 17 publications

References 40 publications

Role of the leukocyte response in normal and immunocompromised host after Clostridium difficile infection

Role of the leukocyte response in normal and immunocompromised host after Clostridium difficile infection

A Clostridium difficile onkológiai vonatkozásai

Are Antimotility Agents Safe for Use in Clostridioides difficile Infections? Results From an Observational Study in Malignant Hematology Patients

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