title: Clostridium difficile infection after allogeneic hematopoietic stem cell transplantation: incidence, risk factors, and outcome.
abstract: Clostridium difficile (C. difficile) infection was observed in 13% of recipients after hematopoietic stem cell transplantation (HSCT), mainly in the first month posttransplantation. Risk factors were cord blood as the source of stem cells, acute graft-versus-host disease (GVHD), and total body irradiation (TBI). No association was found with an increased risk of mortality. The purpose of this study was to evaluate the incidence, risk factors, and outcome of C. difficile infection (CDI) after HSCT. We conducted a single-center, retrospective, cohort study on all patients who received an allogeneic HSCT from January 2004 to December 2007. All patients with diarrhea in the first year after HSCT were tested for the presence of C. difficile in stools. Among the 407 assessable patients, 53 presented at least 1 CDI in the first year post-HSCT. The total incidence rate was 5.6 cases of CDI per 10,000 patient-days. Fifty percent of cases were diagnosed in the first month after HSCT, and 95% occurred during the first 6 months. Fewer than 5% of patients with CDI had severe diarrhea and severe complications were never observed. TBI in the conditioning regimen, cord blood as the source of stem cells, and acute graft-versus-host disease (aGVHD) were independently associated with CDI. Six patients (11%) had a recurrence of CDI. Four patients required second-line treatment with vancomycin. With a median follow-up of 22 months, the 2-year overall survival rates were similar between patients who presented a CDI and those who did not. CDI was observed in approximately 13% of recipients after HSCT, mainly in the first month posttransplantation and was associated with CB, aGVHD, and TBI. CDI was not associated either with severe complications or with an increased risk of mortality in this large cohort of patients.
authors.affiliation: Service Hématologie Greffe, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, Paris, France. lisewillems2@gmail.com
authors.forename: Lise
authors.initials: L
authors.lastname: Willems
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.forename: Matthieu
authors.initials: M
authors.lastname: Lafaurie
authors.forename: Isabelle
authors.initials: I
authors.lastname: Casin
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.forename: Aliénor
authors.initials: A
authors.lastname: Xhaard
authors.forename: Anna Lisa
authors.initials: AL
authors.lastname: Andreoli
authors.forename: Paula
authors.initials: P
authors.lastname: Rodriguez-Otero
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dhedin
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000209:etiology*; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000658:Amoxicillin