Abstract
A prospective, consecutive study of the aetiology of treatment-associated diarrhoea was conducted in 25 patients with disseminated germ cell cancer treated with intensive chemotherapy. Clostridium difficile was isolated in 45% of the diarrhoea episodes, which makes this species the most important bacterial pathogen in the development of clinically significant diarrhoea in this group of immunocompromised patients.
Highlights
During 90 cycles of cytotoxic chemotherapy in a homogenous cohort of patients with cancer requiring intensive treatment clinical significant episodes of diarrhoea were present in 31 cycles (34%) in 21 patients
In 14 of these episodes (45%) a culture of Clostridium difficile was made from faecal specimens
Four patients had one episode of C. dificile diarrhoea, two patients had two episodes separated by negative cultures and absence of clinical symptoms for more than 4 weeks, and two patients had three episodes each
Summary
During a period of 24 months a prospective, consecutive study of the bacteriology of diarrhoea was done in patients with disseminated germ cell cancer treated with high-dose cisplatin, etoposide and bleomycin in cycles every 3rd week (Daugaard & R0rth, 1986). The patients were treated in the same department throughout the study. All patients received ketoconazole 200 mg daily from day six after chemotherapy and throughout the leukopenic phase (< 1.0 x 109 leukocytes/l). During febrile episodes (>38.5°C rectally) while leukopenic, the patients were given empiric treatment with cefotaxime 2 g q 8 h or other agents according to microbiological findings. In 77% of the series the patients were leukopenic for a median of 6 days (range 1-16 days). In patients with diarrhoea faecal specimens were cultured for Clostridium difficile and for other
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