Risk Factors and Outcome of C. difficile Infection after Hematopoietic Stem Cell Transplantation
Autor: | Paola Deias, Michela Cerno, Renato Fanin, Vera Radici, Antonella Geromin, Rossella Stella, Francesca Patriarca, Carlo Tascini, Giuseppe Petruzzellis, Miriam Isola, Alessandra Sperotto, Chiara Rosignoli, Alessandra Arzese, Marco Girgenti, Martalisa Battista, Gabriele Facchin |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
autologous stem cell transplantation genetic structures medicine.medical_treatment lcsh:Medicine Hematopoietic stem cell transplantation Gastroenterology C. difficile infection 03 medical and health sciences 0302 clinical medicine Autologous stem-cell transplantation allogeneic stem cell transplantation Internal medicine medicine risk factors Cumulative incidence Fidaxomicin Allogeneic stem cell transplantation Autologous stem cell transplantation Outcome Risk factors business.industry Incidence (epidemiology) lcsh:R Retrospective cohort study General Medicine surgical procedures operative 030220 oncology & carcinogenesis outcome Vancomycin business 030215 immunology Abdominal surgery medicine.drug |
Zdroj: | Journal of Clinical Medicine, Vol 9, Iss 3673, p 3673 (2020) Journal of Clinical Medicine Volume 9 Issue 11 |
ISSN: | 2077-0383 |
Popis: | Patients who undergo hematopoietic stem cell transplants (HSCT) are at major risk of C. difficile (CD) infection (CDI), the most common cause of nosocomial diarrhea. We conducted a retrospective study, which enrolled 481 patients who underwent autologous (220) or allogeneic HSCT (261) in a 5-year period, with the aim of identifying the incidence, risk factors and outcome of CDI between the start of conditioning and 100 days after HSCT. The overall cumulative incidence of CDI based upon clinical evidence was 5.4% (95% CI, 3.7% to 7.8%), without any significant difference between the two types of procedures. The median time between HSCT and CDI diagnosis was 12 days. Out of 26 patients, 19 (73%) with clinical and symptomatic evidence of CDI were positive also for enzymatic or molecular detection of toxigenic CD in particular, in 5 out of 26 patients (19%) CD binary toxin was also detected. CDI diagnoses significantly increased in the period 2018&ndash 2019, since the introduction in the microbiology lab unit of the two-step diagnostic test based on GDH immunoenzymatic detection and toxin B/binary toxin/027 ribotype detection by real-time PCR. Via multivariate analysis, abdominal surgery within 10 years before HSCT (p = 0.002), antibiotic therapy within two months before HSCT (p = 0.000), HCV infection (p = 0.023) and occurrence of bacterial or fungal infections up to 100 days after HSCT (p = 0.003) were significantly associated with a higher risk of CDI development. The 26 patients were treated with first-line vancomycin (24) or fidaxomicine (2) and only 2 patients needed a second-line treatment, due to the persistence of stool positivity. No significant relationship was identified between CDI and the development of acute graft versus host disease (GVHD) after allogeneic HSCT. At a median follow-up of 25 months (range 1&ndash 65), the cumulative incidence of transplant related mortality (TRM) was 16.6% (95% CI 11.7% to 22.4%) and the 3-year overall survival (OS) was 67.0% (95% CI 61.9% to 71.6%). The development of CDI had no significant impact on TRM and OS, which were significantly impaired in the multivariate analysis by gastrointestinal and urogenital comorbidities, severe GVHD, previous infections or hospitalization within two months before HSCT, active disease at transplant and occurrence of infections after HSCT. We conclude that 20% of all episodes of diarrhea occurring up to 100 days after HSCT were related to toxigenic CD infection. Patients with a history of previous abdominal surgery or HCV infection, or those who had received broad spectrum parenteral antibacterial therapy were at major risk for CDI development. CDIs were successfully treated with vancomycin or fidaxomicin after auto-HSCT as well as after allo-HSCT. |
Databáze: | OpenAIRE |
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