Clostridium difficile-associated disease in allogeneic hematopoietic stem-cell transplant recipients: risk associations, protective associations, and outcomes.
The purpose of this study was to evaluate risk factors, protective factors, and outcomes associated with Clostridium difficile-associated disease (CDAD) in allogeneic hematopoietic stem-cell transplant (HSCT) recipients. A case-control study was performed with 37 CDAD cases and 67 controls. In the multivariable logistic regression analysis, receipt of a third or fourth generation cephalosporin was associated with increased risk of CDAD (OR = 4.6, 95% CI 1.6-13.1). Receipt of growth factors was associated with decreased risk of CDAD (OR=0.1, 95% CI 0.02-0.3). Cases were more likely to develop a blood stream infection after CDAD than were controls at any point before discharge (p < 0.001). CDAD cases were more likely than controls to develop new onset graft-vs.-host disease (GVHD) (p < 0.001), new onset severe GVHD (p < 0.001), or new onset gut GVHD (p = 0.007) after CDAD/discharge. Severe CDAD was a risk factor for death at 180 d in multivariable Cox proportional hazards regression (HR=2.6, 95% CI 1.1-6.2). CDAD is a significant cause of morbidity and mortality in allogeneic HSCT patients, but modifiable risk factors exist. Further study is needed to determine the best methods of decreasing patients' risk of CDAD.
Dubberke
Erik R
ER
Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. edubberk@im.wustl.edu
Reske
Kimberlay A
KA
Srivastava
Anand
A
Sadhu
Justin
J
Gatti
Robert
R
Young
Rebecca M
RM
Rakes
Lauren C
LC
Dieckgraefe
Brian
B
DiPersio
John
J
Fraser
Victoria J
VJ
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000378:metabolism; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000382:microbiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult
D007166:Immunosuppressive Agents