Clostridium difficile infection is a frequent but well-controlled event after hematopoietic cell transplantation

Abstract

Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea and represents a frequent and important source of gastrointestinal morbidity after hematopoietic stem cell transplantation (HSCT). Patients undergoing HSCT have several risk factors for the development of CDI, including multiple prior hospitalizations, frequent use of wide spectrum antibiotics, diseaseand treatment-related immunosuppression and mucosal barrier disruption secondary to conditioning regimens, particularly when they are myeloablative or include total body irradiation. Consequently, patients undergoing HSCT have an incidence of CDI that is higher than the general hospitalized population; it is as high as 15–30% after allogeneic HSCT.1 The majority of reports of CDI in HSCT patients originate from transplant centers located in developed countries. The manuscript by Pilcante et al.2 is the first report of the incidence, risk factors and outcomes of CDI in patients undergoing HSCT in an academic medical center in Chile. The results presented are compatible with other reports, confirming the global importance of CDI in HSCT patients. When compared to previous reports, the incidence of CDI observed in this study appears to be in the lower portion of the reported spectrum, possibly as a result of multiple factors, including antibiotic use patterns, cultural dietary habits, and possibly the degree of C. difficile colonization affecting the general hospitalized patient population of Chile. Recent reports by Kinnebrew3 and Bruminhent4 show high rates of colonization by C. difficile at the time of admission