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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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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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