Chemotherapy patients with C. difficile colitis have outcomes similar to immunocompetent C. difficile patients.
BACKGROUND
Clostridium difficile colitis (CDC) patients receiving chemotherapy for hematologic malignancies are anticipated to have worse outcomes than immunocompetent CDC patients.


METHODS
An IRB approved retrospective cohort study (2004-2009) identified an equal number (n = 49) of CDC inpatients receiving chemotherapy for hematologic malignancies (CDC-HM) as well as CDC patients without malignancies (CDC-NM). Chi-squared tests, linear regression, and analysis of variance were used to compare outcomes.


RESULTS
No difference (p > 0.05) was noted between groups regarding age, hypertension, diabetes, COPD, or coronary artery disease. Approximately 62 % of CDC-HM patients required colony-stimulating factor for neutropenia. There was no difference (p > 0.05) in peak lactate or creatinine levels. None of the CDC-HM group required colectomy, while four CDC-NM patients required surgery (p = 0.04); neither group experienced death. No differences were noted regarding need for ICU admission for CDC or the need for vasopressors (p > 0.05). Mean hospital length of stay was longer for the CDC-HM group (22 days vs. 10 days; p = 0.001).


CONCLUSIONS
CDC-HM patients had longer lengths of stay than CDC-NM patients without an increase in rates of death, colectomy, or ICU admission. Outcomes in CDC-HM are better than many would anticipate, underscoring the current knowledge deficit regarding C. difficile infection.
Department of Surgery, Division of Colorectal Surgery, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA. dstewart@hmc.psu.edu
David B
DB
Stewart
Emmanuel
E
Yacoub
Junjia
J
Zhu
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016360:Clostridioides difficile; D015331:Cohort Studies; D003082:Colectomy / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D003422:Critical Care / Q000706:statistics & numerical data; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D014662:Vasoconstrictor Agents; D008795:Metronidazole