Is there increased risk of clostridium difficile infection with hematologic malignancies?

Abstract

e19705 Background: Clostridium difficile (C. difficile) infection has become a significant health care issue. Antibiotic exposure is a known risk factor for this infection. Current febrile neutropenia (F&N) management guidelines recommend the initiation of broad-spectrum antibiotics, even if no infection is identified. This may place cancer patients with F&N at increased risk for C. difficile infection. We aim to compare the characteristics between cancer patients who developed or did not develop a C. difficile infection after an episode of F&N. Methods: Between 2005 and 2009, medical records from our institutions were reviewed to identify patients hospitalized for fever, neutropenia and C. difficile infection. Patients with ANC >500 x 109/L, were not treated for their F&N, or had F&N for reasons other than malignancy or chemotherapy were excluded. The primary outcome was a positive C. difficile test after an F&N episode. Logistic regression tests were used to compare characteristics between C. difficile-positive and negative groups. Results: 139 patients with F&N were identified, 28 of whom were diagnosed with C. difficile infection within 3 months of admission (20%). Logistic regression tests comparing C. difficile-positive and negative patients showed statistically significant differences in duration of hospital stay (24 vs. 9 days; OR 1.06 95% CI 1.03-1.1, p=0.0004), total antibiotic days (23 vs. 11 days, OR 1.04 95% CI 1.01-1.07, p=0.001) and having a primary diagnosis of hematologic vs. solid malignancy (OR 2.6 95% CI 1.1-6.5, p=0.03). There were no significant differences in age, ANC or duration of neutropenia between the C. difficile-positive and negative groups. Conclusions: Patients with hematologic malignancies had a higher OR of developing C. difficile infection after an F&N episode than patients with solid tumors. There were also small but significant increases in duration of hospital stay and total antibiotic days during F&N episodes in cancer patients who later developed C. difficile infection. These findings suggest that further study is needed into C. difficile prevention strategies in specific types of cancer patients.