Poorer outcomes among cancer patients diagnosed with Clostridium difficile infections in United States community hospitals

Andrew Delgado,Kelly R Reveles,Ivan A Reveles,Felicia T Cabello

doi:10.1186/s12879-017-2553-z

Abstract

BackgroundCancer predisposes patients to Clostridium difficile infection (CDI) due to health care exposures and medications that disrupt the gut microbiota or reduce immune response. Despite this association, the national rate of CDI among cancer patients is unknown. Furthermore, it is unclear how CDI affects clinical outcomes in cancer. The objective of this study was to describe CDI incidence and health outcomes nationally among cancer patients in the United States (U.S.).MethodsData for this study were obtained from the U.S. National Hospital Discharge Surveys from 2001 to 2010. Eligible patients included those at least 18 years old with a discharge diagnosis of cancer (ICD-9-CM codes 140–165.X, 170–176.X, 179–189.X, 190–209.XX). CDI was identified using ICD-9-CM code 008.45. Data weights were applied to sampled patients to provide national estimates. CDI incidence was calculated as CDI discharges per 1000 total cancer discharges. The in-hospital mortality rate and hospital length of stay (LOS) were compared between cancer patients with and without CDI using bivariable analyses.ResultsA total of 30,244,426 cancer discharges were included for analysis. The overall incidence of CDI was 8.6 per 1000 cancer discharges. CDI incidence increased over the study period, peaking in 2008 (17.2 per 1000 cancer discharges). Compared to patients without CDI, patients with CDI had significantly higher mortality (9.4% vs. 7.5%, p < 0.0001) and longer median LOS (9 days vs. 4 days, p < 0.0001).ConclusionsCDI incidence is increasing nationally among cancer patients admitted to U.S. community hospitals. CDI was associated with significantly increased mortality and hospital LOS.

Highlights

Cancer predisposes patients to Clostridium difficile infection (CDI) due to health care exposures and medications that disrupt the gut microbiota or reduce immune response
Prior studies have shown that immunosuppressed patients who develop CDI are at higher risk for poor clinical outcomes [5, 6]
As gut microbiota play a role in preventing C. difficile colonization and virulence, these alterations can lead to CDI [7]

Summary

Introduction

Cancer predisposes patients to Clostridium difficile infection (CDI) due to health care exposures and medications that disrupt the gut microbiota or reduce immune response. Despite this association, the national rate of CDI among cancer patients is unknown. Clostridium difficile is the most common pathogen contributing to healthcare-associated infections [1] This Gram-positive, anaerobic bacterium can colonize the human gut, typically following health care contact and exposure to agents that disrupt the normal gut microbiota, like antibiotics. One study found that the rate of hospital-onset CDI was twice as high among cancer patients as compared to all other inpatients [4] This association is likely due to a number of factors. As gut microbiota play a role in preventing C. difficile colonization and virulence, these alterations can lead to CDI [7]

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