Abstract
ObjectivesIdentify risk factors for Clostridium difficile infection (CDI) and assess CDI outcomes among Australian patients with a haematological malignancy.MethodsA retrospective cohort study involving all patients admitted to hospitals in Western Australia with a haematological malignancy from July 2011 to June 2012. Hospital admission data were linked with all hospital investigated CDI case data. Potential risk factors were assessed by logistic regression. The risk of death within 60 and 90 days of CDI was assessed by Cox Proportional Hazards regression.ResultsThere were 2085 patients of whom 65 had at least one CDI. Twenty percent of CDI cases were either community-acquired, indeterminate source or had only single-day admissions in the 28 days prior to CDI. Using logistic regression, having acute lymphocytic leukaemia, neutropenia and having had bacterial pneumonia or another bacterial infection were associated with CDI. CDI was associated with an increased risk of death within 60 and 90 days post CDI, but only two deaths had CDI recorded as an antecedent factor. Ribotyping information was available for 33 of the 65 CDIs. There were 19 different ribotypes identified.ConclusionsNeutropenia was strongly associated with CDI. While having CDI is a risk factor for death, in many cases it may not be a direct contributor to death but may reflect patients having higher morbidity. A wide variety of C. difficile ribotypes were found and community-acquired infection may be under-estimated in these patients.
Highlights
Using logistic regression, having acute lymphocytic leukaemia, neutropenia and having had bacterial pneumonia or another bacterial infection were associated with Clostridium difficile infection (CDI)
While having CDI is a risk factor for death, in many cases it may not be a direct contributor to death but may reflect patients having higher morbidity
Clostridium difficile infection (CDI) is a well-recognised nosocomial infection, amongst patients treated with antibiotics
Summary
Clostridium difficile infection (CDI) is a well-recognised nosocomial infection, amongst patients treated with antibiotics. Since 2003, the rate of healthcare-associated CDI (HA-CDI) has escalated in North America and Europe with the emergence of a new virulent strain (PCR ribotype 027/North American pulse-field type 1) [1,2]. The incidence of CDI amongst patients with haematological malignancies is much higher than amongst hospitalised patients with other conditions [6]. Certain malignancies such as acute myeloid leukaemia (AML) [7], procedures such as stem cell transplants [8,9,10,11], prolonged neutropenia [7,12], and treatment with particular antibiotics [7,12] have been previously documented as being associated with CDI in this group
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