title: Clostridium difficile infection after adult autologous stem cell transplantation: a multicenter study of epidemiology and risk factors.
abstract: We sought to describe the epidemiology of Clostridium difficile infection (CDI) among adult recipients of autologous hematopoietic stem cell transplantation (auto-HSCT) within the first year after HSCT in centers with variable epidemiology of hypertoxigenic strains. A multicenter, retrospective nested case-control study was conducted among 873 auto-HSCT recipients at Johns Hopkins Hospital (JHH) and Hôpital Maisonneuve-Rosemont (HMR) between January 2003 and December 2008. Despite center differences in the prevalence of NAP-1 strains during the study period (21% to 43% at JHH versus 80% to 84% in HMR), the 1-year incidence of CDI was similar in the 2 hospitals (6.2% at JHH versus 5.7% at HMR). The median time to infection was 11 days (interquartile range, 1 to 27 days). In case-control analyses, grade ≥2 mucositis (odds ratio [OR], 3.00; P = .02) and receipt of a fourth-generation cephalosporin (OR, 2.76; P = .04) were identified as predictors for CDI. Mucositis was the strongest predictor of risk for CDI in multivariate analysis (adjusted OR, 2.77; P = .03). CDI is a common and early complication of auto-HSCT. Treatment-related gastrointestinal mucosal damage, along with the potentially modifiable risk of antimicrobial exposure, influence the risk for CDI early after auto-HSCT.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: calonso@bidmc.harvard.edu.
authors.forename: Carolyn D
authors.initials: CD
authors.lastname: Alonso
authors.forename: Simon F
authors.initials: SF
authors.lastname: Dufresne
authors.forename: David B
authors.initials: DB
authors.lastname: Hanna
authors.forename: Annie-Claude
authors.initials: AC
authors.lastname: Labbé
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Treadway
authors.forename: Dionissios
authors.initials: D
authors.lastname: Neofytos
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bélanger
authors.forename: Carol Ann
authors.initials: CA
authors.lastname: Huff
authors.forename: Michel
authors.initials: M
authors.lastname: Laverdière
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification*; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology* / Q000382:microbiology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D014182:Transplantation, Autologous
keywords: Antibiotics; Clostridium difficile; Mucositis; NAP-1; Stem cell transplantation
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