Clostridium difficile infection in patients with acute myelogenous leukemia and patients undergoing allogeneic stem cell transplantation - epidemiology and risk factor analysis.
Biol Blood Marrow Transplant. 2014 Mar 6;
Authors: Vehreschild MJ, Weitershagen D, Biehl LM, Tacke D, Waldschmidt D, Töx U, Wisplinghoff H, Bergwelt-Baildon MV, Cornely OA, Vehreschild JJ
BACKGROUND: Patients receiving treatment for acute myelogenous leukemia (AML) and recipients of allogeneic stem cell transplantation (aSCT) are at high risk of contracting Clostridium difficile infection (CDI), the most frequently observed nosocomial diarrhea and enterocolitis.
PATIENTS AND METHODS: Data was retrieved from the prospective Cologne Cohort of Neutropenic Patients (CoCoNut). Patients hospitalized for aSCT as well as patients receiving treatment for AML were included into the analysis. Risk factor analysis for the occurrence of CDI was performed by backward-stepwise logistic regression (P<0.1).
RESULTS: During the period from January 2007 to August 2010, 310 hospitalizations of 152 patients with AML and 229 hospitalizations of 223 patients undergoing aSCT were eligible for analysis. Incidence rates for CDI per 10,000 patient days were 17.9 for AML patients and 27.4 for aSCT recipients. Among AML and aSCT patients, median time from initiation of chemotherapy to CDI was 10 days (range: -8-101 days) and 17 days (range: 6-79), respectively. Logistic regression identified carbapenem exposure to be associated with development of CDI in AML patients (odds ratio 2.2) and aSCT recipients (odds ratio 1.4).
CONCLUSION: In both groups, previous exposure to carbapenems was significantly associated with development of CDI. A follow-up study, assessing the effect of an antibiotic stewardship intervention to decrease the administration of carbapenems in hematological high-risk patients is warranted.
PMID: 24607558 [PubMed - as supplied by publisher]