Association of Clostridioides difficile infection with specific malignant conditions

Year 2021, , 124 - 131, 15.09.2021

Chetana Vaıshnavı Megha Sharma Pramod Gupta Rakesh Kochhar

https://doi.org/10.5799/jmid.993843

Abstract

Objectives: Patients with concomitant diseases, particularly malignancies, are at significant risk for Clostridioides difficile infection (CDI). However, very little is known about the association between malignancy and CDI. Therefore, we evaluated the association of CDI in patients with different kinds of malignancies compared to control patients.
Methods: Patients (n=1022) with specific malignancies (496 patients, 328 men), subgrouped as Adenocarcinoma (AC), Hematological malignancies (HM), Multiple myeloma (MM), Pediatric solid tumor (PST), and controls (526 controls, 325 men) without any specific diseases were enrolled in the study. Laboratory data of the patients were reviewed for demographics, antibiotic exposure, clinical symptoms, and fecal Clostridioides difficile toxin (CDT) assay.
Results: Of 1022 patients, 805 received antibiotics. CDT was positive in 168 (80.0%) of those receiving antibiotics and in 42 (20.0%) not receiving antibiotics (p<0.001). Bloody diarrhea was present in 12.4% with CDT status. CDI among patients with malignancy (21.2%) and controls (20.0%) was insignificant (p=0.689). CDT was positive in 7/25 PST (28.0%), 24/96 AC (25.0%), 71/332 HM (21.4%) and 3/43 MM (7.0%) patients, but was not significant (p>0.05). Correlation of different malignant conditions with control and among themselves showed male gender in AC (p=0.039) and HM (p=0.003), antibiotic exposure in MM (p<0.001) and fever in PST and HM subgroups to be significant (p<0.001).
Conclusion: CDT positivity was higher in males and patients exposed to antibiotics. No significant association of CDT was seen in malignant patients compared to the controls, though patients in PST and AC subgroups were more prone to CDI. J Microbiol Infect Dis 2021; 11(3):124-131.

Keywords

Clostridioides difficile infection, Hematologic malignancy, Adenocarcinoma, Multiple myeloma, Pediatric solid tumor

References

• 1. Vaishnavi C. Established and potential risk factors for Clostridium difficile infection. Indian J. Med. Microbiol 2009;27: 291-302.
• 2. Kim SC, Seo MY, Lee JY, et al. Advanced chronic kidney disease: a strong risk factor for Clostridium difficile infection. Korean J Intern Med 2016; 31:125-133.
• 3. Vaishnavi C, Gupta PK, Sharma M, Kochhar R. Pancreatic disease patients are at higher risk for Clostridium difficile infection compared to those with other co-morbidities. Gut Pathogens 2019; 11: Article number: 17.
• 4. McCaleb RV, Gandhi AS, Clark SM, Clemmons AB. Clinical outcomes of acid suppressive therapy use in hematology/oncology patients at an academic medical center. Ann Pharmacother 2016; 50:541-547.
• 5. Yang SW, Moon W. A case of pseudomembranous colitis after paclitaxel and carboplatin chemotherapy. Korean J Gastroenterol2009; 54:328-332.
• 6. Fainstein V, Bodey GP, Fekety R. Relapsing pseudomembranous colitis associated with cancer chemotherapy. J Infect Dis 1981; 143:865.
• 7. Bilgrami S, Feingold JM, Dorsky D, et al. Incidence and outcome of Clostridium difficile infection following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1999; 23:1039‐1042.
• 8. Husain A, Aptaker L, Spriggs DR, Barakat RR. Gastrointestinal toxicity and Clostridium difficile diarrhoea in patients treated with paclitaxel containing chemotherapy regimens. Gynecol Oncol 1998; 71:104-107.
• 9. Chopra T, Chandrasekar P, Salimnia H, et al. Recent epidemiology of Clostridium difficile infection during hematopoietic stem cell transplantation. Clin Transpl 2011; 25: E82-E87.
• 10. Delgado A, Reveles IA, Cabello FT, Reveles KR. Poorer outcomes among cancer patients diagnosed with Clostridium difficile infections in United States community hospitals. BMC Infectious Dis 2017; 17:448.
• 11. Yoon YK, Kim MJ, Sohn JW, et al. Predictors of mortality attributable to Clostridium difficile infection in patients with underlying malignancy. Support Care Cancer 2014; 22:2039-2048.
• 12. Apostolopoulou E, Raftopoulos V, Terzis K, Elefsiniotis I. Infection probability score: a predictor of Clostridium difficile-associated disease onset in patients with haematological malignancy. Eur J Oncol Nurs 2011; 15:404-409.
• 13. Wang MS, Evans CT, Rodriguez T, Gerding DN, Johnson S. Clostridium difficile infection and limitations of markers for severity in patients with hematologic malignancy. Infect Control Hosp Epidemiol 2013; 34:127-132.
• 14. Kyne L, Sougioultzis S, McFarland LV, Kelly CP. Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhoea. Infect Control Hosp Epidemiol 2002; 23:653-659.
• 15. Morris JG Jr, Jarvis WR, Nunez–Montiel OL, et al. Clostridium difficile. Colonization and toxin production in a cohort of patients with malignant hematologic disorders. Arch Intern Med 1984; 144:967-969.
• 16. Rampling A, Warren RE, Bevan PC, et al. Clostridium difficile in haematological malignancy; J Clin Pathol 1985; 38:445-451.
• 17. Avery R, Pohlman B, Adal K, et al. High prevalence of diarrhea but infrequency of documented Clostridium difficile in autologous peripheral blood progenitor cell transplant recipients. Bone Marrow Transplantation 2000; 25:67-69.
• 18. Loo VG, Bourgault AM, Poirier L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 2011; 365:1693‐1703.
• 19. Panichi G, Pantosti A, Gentile G, et al. Clostridium difficile colitis in leukemia patients. Radiation Oncol 2011; 6:89.
• 20. Sedhom D, Elsaid M, Sedhom R. Clostridium difficile infection in patients with hematologic malignancy and neutropenic fever: A clinical overview. Am J Gastroenterol 2016; Abstract 149, page s 83.
• 21. Stewart DB, Yacoub E, Zhu J. Chemotherapy patients with C. difficile colitis have outcomes similar to immunocompetent C. difficile patients. J Gastrointest Surg 2012; 16:1566-1572.
• 22. Schalk E, Bohr UR, Konig B, Scheinpflug K, Mohren M. Clostridium difficile-associated diarrhoea, a frequent complication in patients with acute myeloid leukaemia. Ann Hematol 2010; 89:9-14.
• 23. Vehreschild MJGT, Weitershagen D, Biehl LM, et al. Biol Blood Marrow Transplant 2014; 20: 823e828.
• 24. Prince RM, Krzyzanowska MK, Atenafu EG. Frequency and predictors of hospitalization during chemotherapy: a systematic review. J Clin Oncol 2015;33: Suppl; Abstr 6583.
• 25. Lee-Tsai YL, Luna-Santiago R, Demichelis-Gómez R, et al. Determining the risk factors associated with the development of Clostridium difficile infection in patients with hematological diseases. Blood Res 2019; 54:120-124.
• 26. Simon A, Ammann RA, Bode U, et al. Healthcare-associated infections in pediatric cancer patients: results of a prospective surveillance study from university hospitals in Germany and Switzerland. BMC Infect Dis 2008; 8:70. 27. Castagnola E, Battaglia T, Bandettini R, et al. Clostridium difficile-associated disease in children with solid tumors. Support Care Cancer 2009; 17:321-324.
• 28. Rodrıguez GA, M'erida GA, Muñoz UN, et al. Risk factors associated with Clostridium difficile infection in adult oncology patients. Support Care Cancer 2015; 23:1569-1577.
• 29. Kamthan AG, Bruckner HW, Hirschman SZ. Agus SG. Clostridium difficile diarrhoea induced by cancer chemotherapy. Arch Intern Med 1992; 152:1715-1717.
• 30. Singh M, Vaishnavi C, Kochhar R, Mahmood S. Toxigenic Clostridium difficile isolates from clinically significant diarrhoea in patients from a tertiary care centre. Indian J Med Res. 2017; 145:840-846.