The Evolution of Clostridium difficile Infection in Cancer Patients: Epidemiology, Pathophysiology, and Guidelines for Prevention and Management

Abstract

Clostridium difficile infection (CDI) has emerged as a significant challenge to the healthcare system. The availability of anti-cancer chemotherapeutic regimens has contemporaneously resulted in a larger population of patients who are susceptible to CDI. The outbreak of a novel, hypervirulent, resistant strain, NAP-1/027 as well as resistance to antibiotic therapy have further contributed to an increase in prevalence as well as in disease severity. Recent data show high fatality rates in cancer patients with CDI. In this review, we have discussed the incidence, epidemiology, pathophysiology, clinical signs and symptoms and therapeutic guidelines for patients who are on chemotherapy and present with CDI and highlighted clinical reports documenting severe CDI associated with chemotherapeutic agents such as methotrexate, 5FU, cisplatin, carboplatin, paclitaxel, vinorelbine and cyclophosphamide. The review article also has the discussion of patents pertaining to infections caused by Clostridium difficile in cancer patients. We underscore the urgent need for early recognition and diagnosis of CDI in cancer patients and for the design and implementation of randomized clinical trials of new treatment modalities in the management of chemotherapy- associated CDI.

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

“…The following classes of medications or therapies are used frequently among cancer patients and have been previously associated with CDI: antibiotics [16, 27, 37–39], certain chemotherapeutic agents [40], gastric acid suppressing medications [27], and manipulation of the gastrointestinal tract (e.g., enteral feedings, enemas, stimulants) [41]. …”

Cost-Effectiveness Comparison of Fidaxomicin and Vancomycin for Treatment of Clostridium difficile Infection: A Markov Model Based on Data from a South West Balkan Country in Socioeconomic Transition

“…Service utilization (on which the cost calculations were made) was estimated using guidelines for the treatment colitis induced by C. difficile and already published pharmacoeconomic studies [17,19]. The prices of health services were obtained from the RIHI Tariff Book [20], and the price of fidaxomicin was derived from data gained from a drug manufacturer [21][22][23][24][25][26].…”

The Use of Fidaxomicin for Treatment of RelapsedClostridium difficileInfections in Patients with Cancer

“…One multicenter survey of 11 cancer centers found the rate of hospital‐onset C. difficile in a large group of cancer patients to be twice the rate reported for all U.S. patients (15.8 per 10,000 patient‐days vs 7.4 per 10,000 patient‐days, respectively) . Treatment of CDI in patients with cancer is often difficult because of multiple risk factors that increase the risk for recurrence including treatment with chemotherapy, the use of antimicrobial agents for infectious prophylaxis and treatment, and recurrent hospitalizations . However, FDX has been shown to be effective for CDI treatment in patients with cancer.…”