Clostridioides difficile colonization and infection in patients with newly diagnosed acute leukemia: Incidence, risk factors, and patient outcomes - 30/03/19
, Bert K. Lopansri, MD c, d, Brandon J. Webb, MD b, d, Jana Coombs, BS d, Launce Gouw, MD a, Julie Asch, MD a, Daanish Hoda, MD aRésumé |
Background |
The frequency, risk factors, and outcomes for Clostridioides difficile infection (CDI) in patients with newly diagnosed acute leukemia (AL) admitted for induction therapy are unclear.
Methods |
We studied 509 consecutive patients with AL admitted between 2006 and 2017 and conducted a prospective C difficile surveillance and ribotyping analysis in a subset of these.
Results |
The incidence of CDI was 2.2/1,000 inpatient days during induction, and CDI was rare after discharge. CDI was highest in patients with acute myelogenous leukemia. A hospitalization shortly before admission and administration of a greater number of antibiotics increased the risk for CDI. No single class of antibiotics conveyed an increased risk. All cases were successfully treated, and CDI was not associated with an increase in length of stay, costs, or mortality. In a subgroup analysis, 16% of patients with acute myelogenous leukemia and 4% with other leukemia types were colonized on admission. Colonization was associated with a higher risk of CDI. Ribotyping of available isolates showed 27 different strain types with 014/020 and 027 being the most frequent.
Conclusions |
The number of antibiotics administered are a major risk factor for CDI in patients with AL. However, CDI appears to have minimal clinical impact in this population.
Le texte complet de cet article est disponible en PDF.Key Words : Clostridioides difficile, Leukemia, Antibiotics, Infection
Plan
| Funding/support: This work was supported by a grant from the Intermountain Healthcare Medical and Research Foundation (grant no. 20600035); the Utah Cancer Registry is funded by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (contract no. HHSN261201300017I) and the United States Center for Disease Control and Prevention's National Program of Cancer Registries (cooperative agreement no. NU58DP0063200-01), with additional support from the Utah Department of Health and the University of Utah. |
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| Conflicts of interest: B.K.L. received research support from Cubist/Merck and OpGen in support of projects unrelated to this study. B.K.L. is a member of an advisory board for Merck & Co. There are no other conflicts of interest or financial disclosures to report. |
Vol 47 - N° 4
P. 394-399 - avril 2019 Retour au numéro
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