title: Predictors of mortality attributable to Clostridium difficile infection in patients with underlying malignancy.
abstract: OBJECTIVE
  This study aimed at evaluating the clinical severity and treatment outcomes of Clostridium difficile infections (CDI) and identifying predictors associated with mortality in patients with malignancy.
  
  
  METHODS
  A retrospective study was conducted in a teaching hospital from January 2004 to June 2013. The subjects included adult patients (aged ≥ 18 years) receiving treatment for malignancy whose conditions were complicated by CDI. Clinical severity was determined using the guidelines from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA/IDSA). Multivariate logistic regression analysis was performed to identify predictors independently associated with CDI-related mortality.
  
  
  RESULTS
  Of the 5,594 patients treated for malignancy at the Division of Hematology/Oncology during the study period, 61 (1.1%) had CDI complications. CDI-related mortality was 19.7% (12/61). Twenty-seven (44.3%) patients were diagnosed with neutropenia (ANC ≤ 500/mm(3)) at initial CDI presentation. Forty-one patients (67.2%) received antimicrobial therapy for CDI. Based on the SHEA/IDSA guidelines, only 12 patients (19.7%) presented with severe CDI, but 25 (61.0%) patients experienced treatment failure. Multiple logistic regression modeling showed neutropenia to be an independent risk factor for CDI-related mortality (odds ratio, 5.17; 95% confidence interval, 1.24-21.59).
  
  
  CONCLUSIONS
  This study tracked poor CDI treatment outcomes in patients with malignancy and identified neutropenia as a previously unrecognized risk factor of CDI-related mortality. Alternative definitions of severe CDI that include neutropenia might be necessary to more accurately determine clinical severity.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Yoon
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
authors.forename: Jang Wook
authors.initials: JW
authors.lastname: Sohn
authors.forename: Hye Suk
authors.initials: HS
authors.lastname: Kim
authors.forename: Yoon Ji
authors.initials: YJ
authors.lastname: Choi
authors.forename: Jung Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Seung Tae
authors.initials: ST
authors.lastname: Kim
authors.forename: Kyong Hwa
authors.initials: KH
authors.lastname: Park
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Byung Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Shin
authors.forename: Yeul Hong
authors.initials: YH
authors.lastname: Kim
authors.forename: Yong
authors.initials: Y
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000382:microbiology* / Q000401:mortality* / Q000473:pathology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents