title: Clostridium difficile infection and limitations of markers for severity in patients with hematologic malignancy.
abstract: OBJECTIVE
  To describe characteristics of Clostridium difficile infection (CDI) and markers of severe CDI among patients with hematologic malignancies.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Tertiary care teaching hospital.
  
  
  METHODS
  Inpatients with hematologic malignancies and CDI were age and time matched with 2 control inpatients without hematologic malignancies. Chart reviews were performed, and C. difficile isolates were strain typed.
  
  
  RESULTS
  Case patients (n = 41) and control patients (n = 82) patients were different in respect to receipt of immunosuppressive agents within 2 months (92.7% vs 25.6%; P < .0001); neutropenia within 2 months (75.6% vs 3.7%; P < .0001) and mean (± standard deviation) white blood cell (WBC) count at diagnosis (vs 4.9 ± 14.1 vs 11.8 ± 6.8 x 10(3) cells/mL; P <.0001); baseline mean creatinine level (0.89 ± 0.1 vs 1.6 ± 2.4 mg/dL; P = .003), mean creatinine level at diagnosis (0.83 ± 0.4 vs 1.85 ± 1.9 mg/dL; P = .004), and creatinine increases of 1.5 times over baseline (2.4% vs 15.1%; P = .02). Immunosuppressive agents and creatinine level remained significant in multivariable analysis (P = .03 for both variables). Severity correlated with mortality when measured by alternate severity criteria but not when measured by the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America criteria, which are based solely on WBC count and creatinine elevation. The prevalence of the epidemic BI/NAP1/027 strain was similar in both groups.
  
  
  CONCLUSIONS
  Patients with hematologic malignancies had lower creatinine levels at the time of CDI diagnosis compared with control patients. WBC counts also tended to be lower in case patients. CDI severity criteria based on WBC count and creatinine level may not be applicable to patients with hematologic malignancies.
authors.affiliation: Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA. mwang@lakelandregional.org
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wang
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Tulio
authors.initials: T
authors.lastname: Rodriguez
authors.forename: Dale N
authors.initials: DN
authors.lastname: Gerding
authors.forename: Stuart
authors.initials: S
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000145:classification / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000097:blood / Q000175:diagnosis*; D003404:Creatinine / Q000097:blood; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood / Q000382:microbiology*; D006784:Hospitals, Teaching; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D003404:Creatinine