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Gri N, Longhitano Y, Zanza C, Monticone V, Fuschi D, Piccioni A, Bellou A, Esposito C, Ceresa IF, Savioli G. Acute Oncologic Complications: Clinical-Therapeutic Management in Critical Care and Emergency Departments. Curr Oncol 2023; 30:7315-7334. [PMID: 37623012 PMCID: PMC10453099 DOI: 10.3390/curroncol30080531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction. It is now known that cancer is a major public health problem; on the other hand, it is less known, or rather, often underestimated, that a significant percentage of cancer patients will experience a cancer-related emergency. These conditions, depending on the severity, may require treatment in intensive care or in the emergency departments. In addition, it is not uncommon for a tumor pathology to manifest itself directly, in the first instance, with a related emergency. The emergency unit proves to be a fundamental and central unit in the management of cancer patients. Many cancer cases are diagnosed in the first instance as a result of symptoms that lead the patient's admittance into the emergency room. Materials and Methods. This narrative review aims to analyze the impact of acute oncological cases in the emergency setting and the role of the emergency physician in their management. A search was conducted over the period January 1981-April 2023 using the main scientific platforms, including PubMed, Scopus, Medline, Embase and Google scholar, and 156 papers were analyzed. Results. To probe into the main oncological emergencies and their management in increasingly overcrowded emergency departments, we analyzed the following acute pathologies: neurological emergencies, metabolic and endocrinological emergencies, vascular emergencies, malignant effusions, neutropenic fever and anemia. Discussion/Conclusions. Our analysis found that a redefinition of the emergency department connected with the treatment of oncology patients is necessary, considering not only the treatment of the oncological disease in the strict sense, but also the comorbidities, the oncological emergencies and the palliative care setting. The need to redesign an emergency department that is able to manage acute oncological cases and end of life appears clear, especially when this turns out to be related to severe effects that cannot be managed at home with integrated home care. In conclusion, a redefinition of the paradigm appears mandatory, such as the integration between the various specialists belonging to oncological medicine and the emergency department. Therefore, our work aims to provide what can be a handbook to detect, diagnose and treat oncological emergencies, hoping for patient management in a multidisciplinary perspective, which could also lead to the regular presence of an oncologist in the emergency room.
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Affiliation(s)
- Nicole Gri
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Christian Zanza
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Valentina Monticone
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Damiano Fuschi
- Department of Italian and Supranational Public Law, School of Law, University of Milan, 20122 Milan, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy
| | | | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Azamgarhi T, Warren S, Fouch S, Standing JF, Gerrand C. Prophylactic antibiotics for massive endoprostheses in orthopaedic oncology. Bone Joint J 2023; 105-B:850-856. [PMID: 37524359 DOI: 10.1302/0301-620x.105b8.bjj-2022-1418.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
The recently published Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial found no benefit in extending antibiotic prophylaxis from 24 hours to five days after endoprosthetic reconstruction for lower limb bone tumours. PARITY is the first randomized controlled trial in orthopaedic oncology and is a huge step forward in understanding antibiotic prophylaxis. However, significant gaps remain, including questions around antibiotic choice, particularly in the UK, where cephalosporins are avoided due to concerns of Clostridioides difficile infection. We present a review of the evidence for antibiotic choice, dosing, and timing, and a brief description of PARITY, its implication for practice, and the remaining gaps in our understanding.
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Affiliation(s)
- Tariq Azamgarhi
- Pharmacy Department, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Simon Warren
- Bone Infection Unit, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Sarah Fouch
- School of Pharmacy and Biomedical Sciences, Portsmouth, UK
| | - Joseph F Standing
- Infection, Inflammation and Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Craig Gerrand
- Division of Orthopaedic Oncology, Royal National Orthopaedic Hospital NHS Trust Sarcoma Unit, London, UK
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De-la-Rosa-Martinez D, Rivera-Buendía F, Cornejo-Juárez P, García-Pineda B, Nevárez-Luján C, Vilar-Compte D. Risk factors and clinical outcomes for Clostridioides difficile infections in a case control study at a large cancer referral center in Mexico. Am J Infect Control 2022; 50:1220-1225. [PMID: 35172185 DOI: 10.1016/j.ajic.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) is recognized as the leading cause of nosocomial diarrhea. This study describes CDI's clinical characteristics, risk factors, and outcomes in the cancer population. METHODS We conducted a case-control study on cancer patients from 2015-2018 at the Instituto Nacional de Cancerologia in Mexico. CDI case was defined as diarrhea episode and positive polymerase chain reaction (PCR) for toxigenic strains. Controls were cancer diagnosis-matched patients with diarrhea and negative PCR. Healthcare Facility-Onset (HO-CDI) and Community-Onset, Healthcare Facility-Associated (CO-HCFA-CDI) rates were calculated. For assessing associations, univariate and multivariate logistic regression analyses were conducted. RESULTS We included 148 CDI cases and 148 controls. The CDI rate was 4.1 per 10,000 patient-days and 2.1 per 1,000 patient admissions for HO-CDI and CO-HCFA-CDI episodes, respectively. Clinical characteristics associated with CDI were fever, abdominal pain, and ≥4 episodes of diarrhea/24h. Previous use of proton pump inhibitors (P=.003), fluoroquinolones (P=.016), and cephalosporins (P=.026) increased the risk for CDI acquisition, while higher age (P=.022) and male gender (P=.015) were related to severe episodes. Thirty-day all-cause mortality was higher among CDI patients (18%) than controls (9%). CONCLUSION The CDI rate was lower compared to other series. The incidence of CO-HCFA-CDI episodes increased, and HO-CDI cases decreased from 2016 to 2018. Risk factors for acquisition and severe infection were similar to those reported in non-cancer populations.
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Affiliation(s)
| | - Frida Rivera-Buendía
- Instituto Nacional de Cancerologia, Department of Infectious Diseases, Mexico City, Mexico
| | | | - Bertha García-Pineda
- Instituto Nacional de Cancerologia, Department of Infectious Diseases, Mexico City, Mexico
| | - Carolina Nevárez-Luján
- Instituto Nacional de Cancerologia, Department of Infectious Diseases, Mexico City, Mexico
| | - Diana Vilar-Compte
- Instituto Nacional de Cancerologia, Department of Infectious Diseases, Mexico City, Mexico.
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Milenković B, Šuljagić V, Perić A, Dragojević-Simić V, Tarabar O, Milanović M, Putić V, Tomić D, Miljković B, Vezmar Kovačević S. Outcomes of Clostridioides difficile infection in adult cancer and non-cancer patients hospitalised in a tertiary hospital: a prospective cohort study. Eur J Hosp Pharm 2022; 29:e15-e22. [PMID: 33579720 PMCID: PMC8899674 DOI: 10.1136/ejhpharm-2020-002574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is one of the most common healthcare-associated (HA) infections. Cancer patients, particularly haemato-oncological patients, have an increased risk for CDI due to more risk factors compared with non-cancer patients. The aim of this study was to investigate differences in outcomes associated with HA CDI in patients with solid and haematological malignancies compared with patients with no underlying malignant disease in a tertiary healthcare centre in Serbia. METHODS A prospective cohort study was conducted including adult patients diagnosed with an initial episode of HA CDI. Their demographic and clinical characteristics associated with risk factors for CDI were documented. Outcomes such as all-cause 30-day mortality, cure of infection, diarrhoea relaps and recurrence of disease were followed. Patients were assigned to cancer and non-cancer groups. Within the cancer group, patients were divided into the solid tumour subgroup and haematological malignancy subgroup. RESULTS During a 7-year period, HA CDI was observed in 28 (5.1%) patients with haematological malignancy, 101 (18.3%) patients with solid tumours and 424 (76.7%) non-cancer patients. Older age (OR 1.04, 95% CI 1.02 to 1.07, p<0.001), admission to the intensive care unit (ICU) (OR 2.61, 95% CI 1.37 to 4.95, p=0.003), mechanical ventilation (OR 5.19, 95% CI 2.78 to 9.71, p<0.001) and use of antibiotics prior to CDI (OR 1.04, 95% CI 1.02 to 1.06, p=0.02) were associated with increased mortality. Compared with patients with solid tumours, patients with haematological malignancy were younger (65 vs 57 years, p=0.015), did not require ICU admission (25.0% vs 0%) or mechanical ventilation (8.9% vs 0%) and were treated longer with antibiotics prior to CDI (14 vs 24 days, p=0.002). CONCLUSIONS Patients with haematological malignancy were exposed to different risk factors for CDI associated with mortality compared with patients with solid tumours and non-cancer patients. Older age, ICU stay and mechanical ventilation, but not presence or type of cancer, predicted the all-cause 30-day mortality.
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Affiliation(s)
| | - Vesna Šuljagić
- Medical Faculty University of Defence, Belgrade, Serbia
- Section for Prevention and Control of Nosocomial Infections, Military Medical Academy, Belgrade, Serbia
| | - Aneta Perić
- Department of Pharmacy, Military Medical Academy, Belgrade, Serbia
- Medical Faculty University of Defence, Belgrade, Serbia
| | - Viktorija Dragojević-Simić
- Medical Faculty University of Defence, Belgrade, Serbia
- Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
| | - Olivera Tarabar
- Medical Faculty University of Defence, Belgrade, Serbia
- Clinic for Haematology, Military Medical Academy, Belgrade, Serbia
| | - Milomir Milanović
- Medical Faculty University of Defence, Belgrade, Serbia
- Clinic for Infectious and Tropic Diseases, Military Medical Academy, Belgrade, Serbia
| | - Vesna Putić
- Department of Pharmacy, Military Medical Academy, Belgrade, Serbia
- Medical Faculty University of Defence, Belgrade, Serbia
| | - Diana Tomić
- Institute of Microbiology, Military Medical Academy, Belgrade, Serbia
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy University of Belgrade, Belgrade, Serbia
| | - Sandra Vezmar Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy University of Belgrade, Belgrade, Serbia
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To study the contributing factors and outcomes of Clostridioides difficile infection in patients with solid tumors. Heliyon 2021; 7:e08450. [PMID: 34926847 PMCID: PMC8646976 DOI: 10.1016/j.heliyon.2021.e08450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/18/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background Clostridioides difficile infection (CDI) is a considerable healthcare burden, and now identified as the leading cause of acquired diarrheal illness in patients receiving antibiotics. Patients with malignancies are more prone to acquire CDI, owing to their frequent exposure to risk factors. Objective This study aims to investigate the factors affecting the outcome of Clostridioides Difficile Infection in patients with solid tumors at our community healthcare center. Methods This is a retrospective study that included a total of 59 patients with solid tumors who were hospitalized for Clostridioides difficile infection. Results The median age of the study population was 79 years with 39 males and 20 females. The patients had a diagnosis of a malignancy involving the following sites: prostate (25), lung (19), colon (7), bladder (4), breast (3), and renal (1). There were 52 cases of first time and 7 cases of recurrent CDI admissions. 40 patients were detected to have CDI at presentation while 19 patients were diagnosed with CDI after admission. CDI was categorized as follows: non-severe (29), severe (28), and very severe (2). There were 33 patients on chemotherapy and 20 patients undergoing radiotherapy. Twenty-seven patients had a recent history of cancer care-related procedures or interventions. Twenty-nine patients were from either a rehabilitation center or a long-term nursing care facility. There were 39 recent hospitalizations with 29 patients receiving antibiotics. Almost half of the patients were on proton pump inhibitors (29) and 12 were on steroids (20.3%) at the time of developing CDI. Patients with a high-risk qSOFA score of 2 or more (p-value = 0.008) or a high white blood cell count of >15 × 109/L (p-value = 0.016) at the time of admission were found to have higher in-hospital mortality. Critical care data suggested that 9 patients required intensive care, 7 patients required vasopressor support, and 6 needed mechanical ventilation. Patients were treated with either vancomycin alone (13), or metronidazole alone (25), or combination therapy with vancomycin + metronidazole (21). The median duration of hospital stay was 6 days with 11 fatalities (18.64%). Conclusions CDI causes significant morbidity in patients with malignancies. A high qSOFA score and leukocytosis are significantly associated with high morbidity and thus should be used to prioritize and intensify inpatient care of these patients.
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Czepiel J, Krutova M, Mizrahi A, Khanafer N, Enoch DA, Patyi M, Deptuła A, Agodi A, Nuvials X, Pituch H, Wójcik-Bugajska M, Filipczak-Bryniarska I, Brzozowski B, Krzanowski M, Konturek K, Fedewicz M, Michalak M, Monpierre L, Vanhems P, Gouliouris T, Jurczyszyn A, Goldman-Mazur S, Wultańska D, Kuijper EJ, Skupień J, Biesiada G, Garlicki A. Mortality Following Clostridioides difficile Infection in Europe: A Retrospective Multicenter Case-Control Study. Antibiotics (Basel) 2021; 10:antibiotics10030299. [PMID: 33805755 PMCID: PMC7998379 DOI: 10.3390/antibiotics10030299] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/17/2022] Open
Abstract
We aimed to describe the clinical presentation, treatment, outcome and report on factors associated with mortality over a 90-day period in Clostridioides difficile infection (CDI). Descriptive, univariate, and multivariate regression analyses were performed on data collected in a retrospective case-control study conducted in nine hospitals from seven European countries. A total of 624 patients were included, of which 415 were deceased (cases) and 209 were still alive 90 days after a CDI diagnosis (controls). The most common antibiotics used previously in both groups were β-lactams; previous exposure to fluoroquinolones was significantly (p = 0.0004) greater in deceased patients. Multivariate logistic regression showed that the factors independently related with death during CDI were older age, inadequate CDI therapy, cachexia, malignancy, Charlson Index, long-term care, elevated white blood cell count (WBC), C-reactive protein (CRP), bacteraemia, complications, and cognitive impairment. In addition, older age, higher levels of WBC, neutrophil, CRP or creatinine, the presence of malignancy, cognitive impairment, and complications were strongly correlated with shortening the time from CDI diagnosis to death. CDI prevention should be primarily focused on hospitalised elderly people receiving antibiotics. WBC, neutrophil count, CRP, creatinine, albumin and lactate levels should be tested in every hospitalised patient treated for CDI to assess the risk of a fatal outcome.
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Affiliation(s)
- Jacek Czepiel
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland; (G.B.); (A.G.)
- Correspondence: ; Tel./Fax: +48-124002022/17
| | - Marcela Krutova
- Department of Medical Microbiology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, 15006 Prague, Czech Republic; or
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
| | - Assaf Mizrahi
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
- Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France;
- Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, 92290 Châtenay Malabry, France
| | - Nagham Khanafer
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
- Unité d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, 69002 Lyon, France;
- Centre International de Recherche en Infectiologie (CIRI), Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Université de Lyon, 69372 Lyon, France
| | - David A. Enoch
- Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK; (D.A.E.); (T.G.)
| | - Márta Patyi
- Hygienic Department, Bács-Kiskun County Teaching Hospital, 6000 Bács-Kiskun, Hungary;
| | - Aleksander Deptuła
- Department of Propaedeutics of Medicine and Infection Prevention, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland;
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - Xavier Nuvials
- Critical Care Department, Vall d’Hebron Hospital, Vall d’Hebron Institut de Recerca (VHIR), SODIR Group, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Hanna Pituch
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
- Department of Medical Microbiology, Medical University of Warsaw, 02-004 Warsaw, Poland;
| | - Małgorzata Wójcik-Bugajska
- Department of Internal and Geriatric Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | - Iwona Filipczak-Bryniarska
- Department of Pain Treatment and Palliative Care, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | - Bartosz Brzozowski
- Department of Gastroenterology and Hepatology, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | - Marcin Krzanowski
- Department of Nephrology and Dialysis Unit, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | | | | | | | - Lorra Monpierre
- Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France;
| | - Philippe Vanhems
- Unité d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, 69002 Lyon, France;
- Centre International de Recherche en Infectiologie (CIRI), Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Université de Lyon, 69372 Lyon, France
| | - Theodore Gouliouris
- Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK; (D.A.E.); (T.G.)
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.J.); (S.G.M.)
| | - Sarah Goldman-Mazur
- Department of Hematology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.J.); (S.G.M.)
| | - Dorota Wultańska
- Department of Medical Microbiology, Medical University of Warsaw, 02-004 Warsaw, Poland;
| | - Ed J. Kuijper
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
- Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Center, 2333 Leiden, The Netherlands
- Centre for Infectious Diseases Research, Diagnostics and Laboratory, Surveillance, Rijksinstituut voor Volksgezondheid en Milieu, 2333 Bilthoven, The Netherlands
| | - Jan Skupień
- Department of Metabolic Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | - Grażyna Biesiada
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland; (G.B.); (A.G.)
| | - Aleksander Garlicki
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland; (G.B.); (A.G.)
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Trends in Incidence and Outcomes of Clostridium difficile Colitis in Hospitalized Patients of Febrile Neutropenia: A Nationwide Analysis. J Clin Gastroenterol 2019; 53:e376-e381. [PMID: 30614941 DOI: 10.1097/mcg.0000000000001171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Clostridium difficile infection (CDI) has been attracting attention lately as the most common hospital acquired infection. Patients with neutropenia because of malignancy seem to be at an increased risk for developing CDI. There is currently limited data that assesses the national burden and outcomes of CDI in Febrile Neutropenia (FN). METHODS We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of FN with or without CDI (ICD-9 codes 288.00, 288.03,780.60, and 008.45) as primary or secondary diagnosis during the period from 2008 to 2014. All analyses were performed with SAS, version 9.4 (SAS Institute). RESULTS From 2008 to 2014 there were total 19422 discharges of FN patients with CDI. There was a rising incidence of CDI in patients with FN from 4.11% (in 2008) to 5.83% (in 2014). The In-hospital mortality showed a decreasing trend from 7.79% (in 2008) to 5.32% (in 2014), likely because of improvements in diagnostics and treatment. The overall mortality (6.37% vs. 4.61%), length of stay >5 days (76.45% vs. 50.98%), hospital charges >50,000 dollars (64.43% vs. 40.29%), colectomy and colostomy (0.35% vs. 0.15%), and discharge to skilled nursing facility (10.47% vs. 6.43%) was significantly more in FN patients with CDI versus without CDI over 7 years (2008 to 2014). Age above 65 years, Hispanic race, hematological malignancies, urban hospital settings, and sepsis were significant predictors of mortality in febrile neutropenia patients with CDI. DISCUSSION Despite the significant decrease in mortality, the incidence of CDI is rising in hospitalized FN patients with underlying hematological malignancies. Risk factor modification, with the best possible empiric antibiotic regimen is imperative for reducing mortality and health care costs in this cohort.
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Bhandari S, Pandey RK, Dahal S, Shahreyar M, Dhakal B, Jha P, Venkatesan T, Saeian K. Risk, Outcomes, and Predictors of Clostridium difficile Infection in Lymphoma: A Nationwide Study. South Med J 2019; 111:628-633. [PMID: 30285271 DOI: 10.14423/smj.0000000000000872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The risk of Clostridium difficile infection (CDI) has not been well studied in patients with lymphoma. We thus sought to determine the risk of CDI in hospitalizations with lymphoma along with its trend, outcomes, and predictors using a large database. METHODS Hospital discharge data from the Nationwide Inpatient Sample (NIS) from 2007 to 2011 were used for the study. Using the International Classification of Diseases, Ninth Revision, Clinical Modification codes, all adult patients aged 18 years or older having a primary diagnosis of lymphoma were queried for the presence of CDI as any of the secondary diagnoses. The risk of CDI in lymphoma and its yearly trend were assessed. We performed multivariate logistic regression to determine the independent risk factors of CDI in lymphoma. Furthermore, we studied mortality and other adverse outcomes of CDI in patients with lymphoma. RESULTS There were 236,312 discharges (weighted) with the primary diagnosis of lymphoma. CDI was present in 2.13% of patients with lymphoma versus 0.8% in the nonlymphoma group (P < 0.001). On multivariate analysis, the significant predictors of CDI in lymphoma were presence of infection (odds ratio [OR] 3.1, 95% confidence interval [CI] 2.7-3.6), stem cell transplant (OR 2.7, 95% CI 2.3-3.4), graft-versus-host disease (OR 1.9, 95% CI 1.4-2.8), race (Asian vs white, OR 1.6, 95% CI 1.1-2.4), chemotherapy (OR 1.6, 95% CI 1.4-1.8), gastrointestinal surgery (OR 1.4, 95% CI 1.2-1.7), and Charlson Comorbidity Index (CCI) (CCI of 2 vs 0-1: OR 1.2, 95% CI 1.1-1.4; CCI of 3 vs 0-1: OR 1.3, 95% CI 1.03-1.6). CDI in lymphoma was associated with worse hospital outcomes such as increased mortality (17% vs 8%), increased length of stay (23.6 vs 9.9 days), mean total hospital charges ($197,015 vs $79,392), rate of intubation (13% vs 4% vs 13%), and rate of total parenteral nutrition (11% vs 3%). CONCLUSIONS Hospitalization with lymphoma was associated with an increased risk of CDI. The significant predictors for CDI in lymphoma were infection, stem cell transplant, graft-versus-host disease, race, chemotherapy, gastrointestinal surgery, and Charlson Comorbidity Index. CDI in lymphoma was associated with increased mortality and other adverse outcomes warranting a need of more vigilance for CDI in patients with lymphoma.
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Affiliation(s)
- Sanjay Bhandari
- From the Divisions of General Internal Medicine, Hematology and Oncology, and Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, and the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York
| | - Ramesh Kumar Pandey
- From the Divisions of General Internal Medicine, Hematology and Oncology, and Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, and the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York
| | - Sumit Dahal
- From the Divisions of General Internal Medicine, Hematology and Oncology, and Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, and the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York
| | - Muhammad Shahreyar
- From the Divisions of General Internal Medicine, Hematology and Oncology, and Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, and the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York
| | - Binod Dhakal
- From the Divisions of General Internal Medicine, Hematology and Oncology, and Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, and the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York
| | - Pinky Jha
- From the Divisions of General Internal Medicine, Hematology and Oncology, and Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, and the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York
| | - Thangam Venkatesan
- From the Divisions of General Internal Medicine, Hematology and Oncology, and Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, and the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York
| | - Kia Saeian
- From the Divisions of General Internal Medicine, Hematology and Oncology, and Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, and the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York
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Klemencic S, Perkins J. Diagnosis and Management of Oncologic Emergencies. West J Emerg Med 2019; 20:316-322. [PMID: 30881552 PMCID: PMC6404710 DOI: 10.5811/westjem.2018.12.37335] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
Oncologic emergencies may be seen in any emergency department and will become more frequent as our population ages and more patients receive chemotherapy. Life-saving interventions are available for certain oncologic emergencies if the diagnosis is made in a timely fashion. In this article we will cover neutropenic fever, tumor lysis syndrome, hypercalcemia of malignancy, and hyperviscosity syndrome. After reading this article the reader should be much more confident in the diagnosis, evaluation, and management of these oncologic emergencies.
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Affiliation(s)
- Sarah Klemencic
- Virginia Tech Carilion School of Medicine, Department of Emergency Medicine, Roanoke, Virginia
| | - Jack Perkins
- Virginia Tech Carilion School of Medicine, Department of Emergency Medicine, Roanoke, Virginia
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10
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Larrainzar-Coghen T, Rodríguez-Pardo D, Barba P, Aguilar-Company J, Rodríguez V, Roig G, Ferrer C, Ruiz-Camps I, Almirante B. Prognosis of Clostridium difficile infection in adult oncohaematological patients: experience from a large prospective observational study. Eur J Clin Microbiol Infect Dis 2018; 37:2075-2082. [PMID: 30073433 DOI: 10.1007/s10096-018-3341-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/24/2018] [Indexed: 12/19/2022]
Abstract
The aim of the study is to evaluate demographics, epidemiology, clinical characteristics, treatment and outcomes of Clostridium difficile infection (CDI) in patients with and without concurrent cancer. This is a prospective cohort study of consecutive primary CDI episodes in adults (January 2006-December 2016). CDI was diagnosed on the presence of diarrhoea and positive stool testing for toxigenic C. difficile. Univariate analysis assessed differences between cancer and non-cancer patients. Risk factors of all-cause 30-day mortality were determinate using the logistic multivariable procedure. In total, 787 CDI episodes were recorded, 191 in cancer patients (median age 64, IQR 50-73). Of these, 120 (63%) had solid and 71 (37%) haematological malignancies (24 received a stem cell transplant). At the CDI diagnosis, 158 (82.7%) cancer patients had prior antibiotics and 150 (78.5%) were receiving proton pump inhibitors. Fifty-seven (80.3%) patients with haematological and 52 (43.3%) with solid malignancies were under chemotherapy at diagnosis; 25 (35.2%) with haematological and 11 (9.2%) with solid malignancies had an absolute neutrophil count < 1000/mm3. Overall, 30-day mortality was higher in cancer patients than in those without (19.2 vs. 8.6% respectively, p < 0.001); recurrence rates did not vary significantly (11.1 vs. 11%, p = 0.936). By type of neoplasm, 30-day mortality was higher in patients with haematological malignancies and solid tumours than in patients without cancer (respectively, 25.4 vs. 8.6%; p < 0.001 and 15 vs. 8.6%; p < 0.001). Our results suggest that the prognosis of CDI (30-day mortality) is poorer in patients with cancer than in those without although percentages of recurrent infection are similar in these two patient populations.
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Affiliation(s)
- Thais Larrainzar-Coghen
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Medicine Department, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Dolors Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Medicine Department, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.
| | - Pere Barba
- Haematology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Aguilar-Company
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Medicine Department, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Medical Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Virginia Rodríguez
- Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Microbiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gloria Roig
- Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Microbiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Ferrer
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Medicine Department, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Ruiz-Camps
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Medicine Department, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain
| | - Benito Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Medicine Department, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain
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11
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Tieu JD, Schmidt SA, Miller JL, Kupiec KE, Skrepnek GH, Liu C, Smith WJ. Clostridium difficile treatment in neutropenic patients: Clinical outcomes of metronidazole, vancomycin, combinations, and switch therapy. J Oncol Pharm Pract 2017; 25:520-528. [DOI: 10.1177/1078155217740945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Clostridium difficile infection treatment guidelines exist for immunocompetent patients; however, there is a paucity of data evaluating clinical outcomes and time to C. difficile-associated diarrhea resolution in neutropenic patients. Objective To assess clinical outcomes in neutropenic patients treated with metronidazole, oral vancomycin, the combination of metronidazole plus oral vancomycin, and switch of metronidazole to oral vancomycin. Methods This retrospective, observational cohort study assessed adult neutropenic inpatients with C. difficile-associated diarrhea treated with metronidazole, oral vancomycin, combination (metronidazole and oral vancomycin), or switch therapy (metronidazole to oral vancomycin). The primary outcome was time to diarrhea resolution based on treatment regimen. Secondary outcomes included C. difficile-associated diarrhea resolution of diarrhea by day 14, recurrence, and occurrence of major complications. Results Overall, 44 patients met full inclusion criteria (52.2% metronidazole monotherapy, 22.7% combination, and 25.0% switch therapy). Two patients on oral vancomycin monotherapy were excluded due to insufficient sample size. Overall time to C. difficile-associated diarrhea resolution was 9.1 ± 10.7 days. The Cox regression results suggested both switch and combination therapy were associated with 65.5% (p = 0.002) and 65.9% (p = 0.046) longer time to C. difficile-associated diarrhea resolution compared to metronidazole monotherapy, respectively. An increasing absolute neutrophil count was associated with an increase in C. difficile-associated diarrhea resolution (p = 0.007). Conclusion Switch or combination therapy was associated with a prolonged time to C. difficile-associated diarrhea resolution. The decision to use switch or combination therapy may represent a surrogate marker for more severe disease and need for therapy escalation. It is unknown if initial therapy with oral vancomycin would provide better outcomes as this could not be assessed.
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Affiliation(s)
| | - Sarah A Schmidt
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Jamie L Miller
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, USA
| | | | - Grant H Skrepnek
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, USA
| | - Connie Liu
- Pharmacy Department, CVS Pharmacy, Dallas, TX, USA
| | - Winter J Smith
- Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA
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12
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Neemann K, Freifeld A. Clostridium difficile–Associated Diarrhea in the Oncology Patient. J Oncol Pract 2017; 13:25-30. [DOI: 10.1200/jop.2016.018614] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Clostridium difficile is the most common cause of nosocomial diarrhea, resulting in significant morbidity and mortality in hospitalized patients. Oncology patients are particularly at risk of this infection secondary to frequent exposure to known risk factors. In a population in which diarrhea is a common adverse effect of chemotherapeutic regimens, diagnosis can be challenging secondary to current limitations in testing to differentiate between colonization and active infection. Although several currently available antimicrobial therapies achieve resolution of symptoms in this population, further research is needed to determine which agent least affects the host intestinal microbiota, especially in times of neutropenia and mucosal barrier injury. The purpose of this article is to review the current literature on the epidemiology, pathogenesis, and management of C difficile–associated diarrhea in the oncology population.
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Affiliation(s)
- Kari Neemann
- University of Nebraska Medical Center, Omaha, NE
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13
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Fernandes R, Mazzarello S, Stober C, Vandermeer L, Dudani S, Ibrahim MFK, Majeed H, Perdrizet K, Shorr R, Hutton B, Fergusson D, Clemons M. Optimal primary febrile neutropenia prophylaxis for patients receiving docetaxel-cyclophosphamide chemotherapy for breast cancer: a systematic review. Breast Cancer Res Treat 2016; 161:1-10. [PMID: 27783280 DOI: 10.1007/s10549-016-4028-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Due to the high rate of febrile neutropenia (FN) with docetaxel-cyclophosphamide (DC) chemotherapy, primary FN prophylaxis is recommended. However, the optimal choice of prophylaxis [i.e., granulocyte-colony stimulating factors (G-CSF) or antibiotics] is unknown. A systematic review was performed to address this knowledge gap. METHODS Embase, Ovid Medline, Pubmed, the Cochrane database of systematic reviews, and Cochrane register of controlled trials were searched from 1946 to April 2016 for studies evaluating primary prophylactic FN treatments in breast cancer patients receiving DC chemotherapy. Outcome measures evaluated included: incidence of FN and treatment-related hospitalizations, chemotherapy dose reduction/delays/discontinuations, and adverse events. Screening and data collection were performed by two independent reviewers. RESULTS Of 2105 identified records, 7 studies (n = 2535) met the pre-specified eligibility criteria. Seven additional studies (n = 621) were identified from prior systematic reviews. There were 3 randomized controlled trials (RCTs) (n = 2256) and 11 retrospective studies (n = 900). Study sample sizes ranged from 30 to 982 patients (median 99.5), evaluating pegfilgrastim (n = 1274), filgrastim (n = 1758), and oral ciprofloxacin (n = 108). Given the heterogeneity of patients and study design, a narrative synthesis of results was performed. Median FN rates with and without primary prophylaxis were 6.6 % (IQR 3.9-10.6 %) and 31.3 % (IQR 25-33 %), respectively. No FN-related deaths were reported. No RCT directly compared G-CSF with antibiotic interventions. CONCLUSIONS Primary FN prophylaxis reduces the incidence of FN. Despite considerable cost and toxicity differences between G-CSF and antibiotics, there is insufficient data to make a recommendation of one strategy over another.
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Affiliation(s)
- Ricardo Fernandes
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | | | - Carol Stober
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Shaan Dudani
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Mohamed F K Ibrahim
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - Habeeb Majeed
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Kirstin Perdrizet
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | | | - Brian Hutton
- Department of Medicine, Clinical Epidemiology Program, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Dean Fergusson
- Department of Medicine, Clinical Epidemiology Program, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada. .,Ottawa Hospital Research Institute, Ottawa, Canada. .,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
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Cózar-Llistó A, Ramos-Martinez A, Cobo J. Clostridium difficile Infection in Special High-Risk Populations. Infect Dis Ther 2016; 5:253-69. [PMID: 27515721 PMCID: PMC5019980 DOI: 10.1007/s40121-016-0124-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Indexed: 02/07/2023] Open
Abstract
Antibiotic use continues to be the most important risk factor for the development of Clostridium difficile infection (CDI) through disruption of the indigenous microbiota of the colon. This factor, together with environmental contamination, makes hospital and other healthcare facilities the perfect breeding ground for the infection. Several groups of patients are exposed to the hospital environment and, at the same time, affected by conditions that can make CDI more prevalent, more severe or make it present a different clinical picture. The list of such conditions appears too extensive to be reviewed in a single article. Nevertheless, several groups, including the critically ill, oncological patients, solid organ and hematopoietic transplant recipients, patients with inflammatory bowel disease, patients with kidney disease and pregnant women, have generated more attention and have been studied in more detail. On the other hand, pediatric patients constitute a controversial group because the large number of asymptomatic carriers makes interpretation of clinical findings and diagnostic tests difficult, as is the development of an appropriate approach to treatment. We present an in-depth discussion of CDI in these high-risk populations and we also review the issue of CDI in pediatric patients.
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Affiliation(s)
- Alberto Cózar-Llistó
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martinez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier Cobo
- Infectious Diseases Service, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo Km 9.1, 28034, Madrid, Spain.
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15
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Chung MS, Kim J, Kang JO, Pai H. Impact of malignancy on Clostridium difficile infection. Eur J Clin Microbiol Infect Dis 2016; 35:1771-1776. [DOI: 10.1007/s10096-016-2725-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/05/2016] [Indexed: 12/22/2022]
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16
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Risk factors associated with Clostridium difficile infection in adult oncology patients. Support Care Cancer 2014; 23:1569-77. [DOI: 10.1007/s00520-014-2506-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/03/2014] [Indexed: 02/07/2023]
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17
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Yoon YK, Kim MJ, Sohn JW, Kim HS, Choi YJ, Kim JS, Kim ST, Park KH, Kim SJ, Kim BS, Shin SW, Kim YH, Park Y. Predictors of mortality attributable to Clostridium difficile infection in patients with underlying malignancy. Support Care Cancer 2014; 22:2039-48. [PMID: 24595407 DOI: 10.1007/s00520-014-2174-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed at evaluating the clinical severity and treatment outcomes of Clostridium difficile infections (CDI) and identifying predictors associated with mortality in patients with malignancy. METHODS A retrospective study was conducted in a teaching hospital from January 2004 to June 2013. The subjects included adult patients (aged ≥ 18 years) receiving treatment for malignancy whose conditions were complicated by CDI. Clinical severity was determined using the guidelines from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA/IDSA). Multivariate logistic regression analysis was performed to identify predictors independently associated with CDI-related mortality. RESULTS Of the 5,594 patients treated for malignancy at the Division of Hematology/Oncology during the study period, 61 (1.1%) had CDI complications. CDI-related mortality was 19.7% (12/61). Twenty-seven (44.3%) patients were diagnosed with neutropenia (ANC ≤ 500/mm(3)) at initial CDI presentation. Forty-one patients (67.2%) received antimicrobial therapy for CDI. Based on the SHEA/IDSA guidelines, only 12 patients (19.7%) presented with severe CDI, but 25 (61.0%) patients experienced treatment failure. Multiple logistic regression modeling showed neutropenia to be an independent risk factor for CDI-related mortality (odds ratio, 5.17; 95% confidence interval, 1.24-21.59). CONCLUSIONS This study tracked poor CDI treatment outcomes in patients with malignancy and identified neutropenia as a previously unrecognized risk factor of CDI-related mortality. Alternative definitions of severe CDI that include neutropenia might be necessary to more accurately determine clinical severity.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
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Green MR, Acharya UH, Yeager AM. Is Fidaxomicin the Drug of Choice for Treating Clostridium difficile–Associated Diarrhea in Patients With Cancer? J Clin Oncol 2013; 31:4376-8. [DOI: 10.1200/jco.2013.52.8513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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