Analyzing the outcome of clostridium difficile infection in cancer patients.

Abstract

e19340 Background: Clostridium difficile infection (CDI) is a considerable health burden, and now identified as the leading cause of acquired diarrhea in patients receiving antibiotics. Cancer patients are more prone to acquire CDI, owing to their frequent exposure to risk factors. This study aims to investigate the factors affecting the outcome of Clostridium Difficile Infection in patients with cancer at our community center. Methods: This is a retrospective study that included a total of 59 cancer patients who were hospitalized for clostridium difficile infection. Results: The median age of the study population was 79 years with 39 males and 20 females. The patients were suffering from cancer located at the following sites: Prostate (25), lung (19), colon (7), bladder (4), breast (3) and renal (1). There were 52 cases of 1st and 7 cases of recurrent CDI admissions. 40 patients detected to have CDI at presentation while 19 patients developed CDI during hospitalization. CDI categories were as follows: Non-severe (29), severe (28), and very severe (3). There were 33 and 20 patients on chemotherapy and radiotherapy respectively. 27 patients had a recent history of cancer care-related procedures or interventions. 29 patients were from either rehab or nursing facility. There were 39 recent hospitalizations with 29 patients receiving antibiotics. Almost half of the patients were on PPI (29) and 12 were on steroids (20.3%) at the time of developing CDI. Patients with a high-risk qSOFA Score of 2 or more (p-value = 0.008) or a high white blood cell count of > 15 X 109/L (p-value = 0.016) were found to have higher in-hospital mortality. Critical care data suggested that 9 patients required intensive care, 7 patients required vasopressor support, and 6 needed mechanical ventilation. Patients were treated with either vancomycin alone (13), or metronidazole alone (25), or combination therapy with vancomycin + metronidazole (21). The median duration of hospital stay was 6 days with 11 fatalities (18.64%). Conclusions: CDI causes significant morbidity in cancer patients. Factors like high qSOFA score and leukocytosis can help to prioritize and intensify the care and in prognosticating the patients.