title: Clostridium difficile infection in pediatric acute myeloid leukemia: from the Canadian Infections in Acute Myeloid Leukemia Research Group.
abstract: BACKGROUND
  The prevalence and severity of Clostridium difficile infection (CDI) has increased over time in adult patients, but little is known about CDI in pediatric cancer. The primary objectives were to describe the incidence and characteristics of CDI in children with de novo acute myeloid leukemia (AML). The secondary objective was to describe factors associated with CDI.
  
  
  METHODS
  We performed a multicenter, retrospective cohort study of children with de novo AML and evaluated CDI. Recurrence, sepsis and infection-related death were examined. Factors associated with CDI were also evaluated.
  
  
  RESULTS
  Forty-three CDI occurred in 37 of 341 (10.9%) patients during 42 of 1277 (3.3%) courses of chemotherapy. There were 6 children with multiple episodes of CDI. Three infections were associated with sepsis, and no children died of CDI. Only 2 children had an associated enterocolitis. Both days of broad-spectrum antibiotics (odds ratio 1.03, 95% confidence interval: 1.01 to 1.06; P = 0.003) and at least 1 microbiologically documented sterile site infection (odds ratio 10.81, 95% confidence interval: 5.88 to 19.89; P < 0.0001) were independently associated with CDI.
  
  
  CONCLUSIONS
  CDI occurred in 11% of children receiving intensive chemotherapy for AML, and outcomes were not severe. CDI is not a prominent issue in pediatric AML in terms of prevalence, incidence or associated outcomes.
authors.affiliation: Pediatrics, IWK Health Centre, Canada.
authors.forename: Victoria
authors.initials: V
authors.lastname: Price
authors.forename: Carol
authors.initials: C
authors.lastname: Portwine
authors.forename: Shayna
authors.initials: S
authors.lastname: Zelcer
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Ethier
authors.forename: Biljana
authors.initials: B
authors.lastname: Gillmeister
authors.forename: Mariana
authors.initials: M
authors.lastname: Silva
authors.forename: Christina
authors.initials: C
authors.lastname: Schindera
authors.forename: Rochelle
authors.initials: R
authors.lastname: Yanofsky
authors.forename: David
authors.initials: D
authors.lastname: Mitchell
authors.forename: Donna L
authors.initials: DL
authors.lastname: Johnston
authors.forename: Victor
authors.initials: V
authors.lastname: Lewis
authors.forename: David
authors.initials: D
authors.lastname: Dix
authors.forename: Sonia
authors.initials: S
authors.lastname: Cellot
authors.forename: Bruno
authors.initials: B
authors.lastname: Michon
authors.forename: Lynette
authors.initials: L
authors.lastname: Bowes
authors.forename: Kent
authors.initials: K
authors.lastname: Stobart
authors.forename: Josee
authors.initials: J
authors.lastname: Brossard
authors.forename: Joseph
authors.initials: J
authors.lastname: Beyene
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis