title: Clostridium difficile-associated diarrhoea, a frequent complication in patients with acute myeloid leukaemia.
abstract: Diarrhoea occurs frequently in neutropenic patients with acute leukaemia receiving chemotherapy and may be caused by either infection- or drug-induced cytotoxicity. Since Clostridium difficile is the most common cause of nosocomial infectious diarrhoea in non-haematologic patients, we were interested in its incidence in patients with acute myeloid leukaemia (AML). In this retrospective study, we analysed 134 patients with AML receiving a total of 301 chemotherapy courses. Diarrhoea occurred during 33% of all courses in 58 patients. C. difficile-associated diarrhoea (CDAD) occurred in 18% of all patients and 9% of all treatment courses. Almost one third of diarrhoea episodes were caused by C. difficile. CDAD was associated with older age (58 vs. 50 years), number of antibiotics administered (2 vs. 1), duration of antibiotic therapy (7 vs. 4 days), ceftazidime as the antibiotic of choice (75% vs. 54%) and duration of neutropenia (12 vs. 7 days) prior to onset of diarrhoea. An increased risk for CDAD was seen for prolonged neutropenia. CDAD responded well to oral metronidazole and/or vancomycin and no patient died of this complication. In conclusion, CDAD is common in patients with AML receiving chemotherapy. C. difficile enterotoxin testing of stool specimens should be included in all symptomatic patients.
authors.affiliation: Department of Haematology/Oncology, Magdeburg University Hospital, Germany. enrico.schalk@med.ovgu.de
authors.forename: Enrico
authors.initials: E
authors.lastname: Schalk
authors.forename: Ulrich R M
authors.initials: UR
authors.lastname: Bohr
authors.forename: Brigitte
authors.initials: B
authors.lastname: König
authors.forename: Katrin
authors.initials: K
authors.lastname: Scheinpflug
authors.forename: Martin
authors.initials: M
authors.lastname: Mohren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D016360:Clostridioides difficile; D003967:Diarrhea / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents