A Retrospective Study Analyzing the Appropriateness of Initial Treatment of Clostridium difficile in Patients with Active Malignancy.

Aaron Fisher,Alexandra Halalau,Ismail Hader,Ewa Gniado,Pradeep Khanal,Molly Orosey,Siddhartha Yadav,Leila Khaddour

doi:10.1155/2018/7192728

Abstract

Background Clostridium difficile infection (CDI) is the leading cause of hospital-associated gastrointestinal illness. Previous studies reported that patients with active malignancy are at high risk for CDIs, and yet they are still classified as nonsevere CDI and initially treated with metronidazole. Our aim is to investigate the need for the escalation of antibiotic therapy in patients with CDI and active cancer treated with oral metronidazole versus oral vancomycin. Methods This is a retrospective study of adult patients admitted with CDI and any underlying active malignancy at Beaumont Hospital, Royal Oak, Michigan, from January 2008 to December 2014. Inclusion criteria included age > 18 years old, polymerase chain reaction- (PCR-) proven CDI, and active malignancy. Results 197 patients were included in the final analysis. 44.8% of the metronidazole group required escalation of therapy compared to 15.2% in the vancomycin group (p value = 0.001). 29.8% of the combination group (metronidazole and vancomycin) underwent deescalation of antibiotics, which was significantly higher compared to 2.2% of patients in the vancomycin group (p value < 0.001). Discussion Our results support the initial use of vancomycin or a combination (metronidazole and vancomycin) versus metronidazole in patients with CDI and active malignancy.

Highlights

Clostridium difficile infection (CDI) is the leading cause of hospital-associated gastrointestinal illness and has been reported to be more prevalent, more severe, more refractory to standard therapy, and more likely to relapse than previously described [1, 2]
The study was a retrospective cohort designed to compare the need for escalation of initial CDI therapy in patients with Clostridium difficile colitis and active malignancy treated with oral metronidazole or oral vancomycin
Our study was not designed to assess the accuracy of current CDI severity classification in patients with active malignancy, our findings suggest that the scoring system from the European Society of Clinical Microbiology and Infectious Disease might underestimate the severity of infection in patients with laboratory abnormalities related to their active malignancies or to their associated treatments

Summary

Introduction

Clostridium difficile infection (CDI) is the leading cause of hospital-associated gastrointestinal illness and has been reported to be more prevalent, more severe, more refractory to standard therapy, and more likely to relapse than previously described [1, 2]. Patients with active malignancy have been considered high risk for developing CDI, as studies have reported that up to 7% of patients receiving chemotherapy will develop CDI and 8.2% may develop severe enterocolitis [6, 7]. Previous studies reported that patients with active malignancy are at high risk for CDIs, and yet they are still classified as nonsevere CDI and initially treated with metronidazole. This is a retrospective study of adult patients admitted with CDI and any underlying active malignancy at Beaumont Hospital, Royal Oak, Michigan, from January 2008 to December 2014. 29.8% of the combination group (metronidazole and vancomycin) underwent deescalation of antibiotics, which was significantly higher compared to 2.2% of patients in the vancomycin group (p value < 0.001). Our results support the initial use of vancomycin or a combination (metronidazole and vancomycin) versus metronidazole in patients with CDI and active malignancy

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