Clostridium difficile infection in hospitalized cancer patients.

Abstract

e20707 Background: The incidence and severity of Clostridium difficileinfection (CDI) has significantly increased over the past decade. Although the epidemiology and treatment of CDI is well elucidated in the non-oncology population, it is poorly understood among cancer patients. CDI prevention is particularly important for patients with cancer, because diarrhea often results in dose reductions or delays of chemotherapy or radiotherapy. Methods: We performed a retrospective study to assess the incidence and severity of C. difficile infection among adult cancer patients admitted to the Oncology Service at “12 de Octubre” University Hospital, from January 2009 to March 2013. All inpatients with diarrhea underwent testing for the presence of C. difficile (enzyme immunoassay for toxins A and B). Chemotherapy administered, and antibiotics used before the development of CDI symptoms, was noted. Results: Of the 230 admitted patients during the 4-year study period, the overall incidence of CDI was 9.6% (N=22). Of these, 8 (36.4%) and 14 patients (63.6%) were deemed to have mild and moderate CDI, respectively. Patients with CDI (N=5, 22.7%) suffered more severe complications than patients with other enteric infections (N=2, 15.4%). There was a slight trend between previous use of antibiotics and CDI (P= 0.09), however we found no relationship between CDI and previous administration of corticosteroids or proton pump inhibitors. With regards to outcome of chemotherapy, patients with platinum-based therapy were more affected by CDI (N=19, 86.3%), and four of them died. Conclusions: Despite a potential decrease in the incidence of CDI in the last years, this infection still contributes substantially to morbidity and possibly mortality in this vulnerable patient population. There was no relationship between gastrointestinal cancer and CDI. Use of carboplatin chemotherapy was significantly associated with CDI, and CDI was more frequent in gynecologic cancer patients, as these patients are more frequently treated with this therapy. Our study supports the possibility of platinum-based chemotherapy as a risk factor for CDI although the reason for the effect is not clear.