A Case Study of Clostridium Difficile Infection in Hemato-Oncological Patients

Antimicrobial treatment is the most important modifiable risk factor for clostridium difficile infection (CDI) in hemato-oncological patients, according to a recent study. Published in the journal Nature, the study was conducted by Thorsten Fuereder, MD, of the Department of Internal Medicine I, at the Medical University of Vienna, in Austria, and colleagues.

“It was the aim of the current study to investigate risk factors for CDI in a large cohort of hemato-oncological patients with microbiologically confirmed CDI,” say the authors. In order to carry out that aim, they compared the data of 144 CDI-positive hemato-oncological patients with matched CDI-negative hemato-oncological patients. The study design was retrospective and all participants were drawn from a single center between January 1, 2004 and December 31, 2014.

The researchers note that “diarrhea was the cause for hospitalization only for a minor subset in both CDI-positive and -negative patients (14.1% vs. 9.2%).” They add that hospitalization was most often elective and that CDI-negative patients elected to be hospitalized more often than CDI-positive patients. Most of the patients developed diarrhea during their hospital stay.

“In total, 83 patients died within 30 days after onset of diarrhea including 47 (33%) and 34 (24%) of CDI positive and -negative patients, respectively,” report the authors. Antimicrobial therapy is a known risk factor for CDI and in the present study, “CDI-positive patients had received somewhat more frequently an antimicrobial agent within four weeks prior to onset of diarrhea as compared to CDI negative patients,” say the researchers.

The authors suggest that one of their findings in particular is remarkable, and say, “a considerable number of CDI-positive patients already received an agent with antimicrobial activity against C. difficile before onset of diarrhea.” They say, “a rational use of antimicrobial agents has to be advocated in hemato-oncologic patients as this is a significant and modifiable risk factor for CDI.”

The researchers conclude that chemotherapy itself is not a risk factor for CDI in this patient population, but that antimicrobial therapy is a major risk factor and they say, “the use of antimicrobial agents should be careful and rational.”

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