title: Clostridium difficile infection in patients with acute myelogenous leukemia and in patients undergoing allogeneic stem cell transplantation: epidemiology and risk factor analysis.
abstract: Patients receiving treatment for acute myelogenous leukemia (AML) and recipients of allogeneic stem cell transplantation (aSCT) are at high risk of contracting Clostridium difficile infection (CDI), the most frequently observed nosocomial diarrhea and enterocolitis. Data were retrieved from the prospective Cologne Cohort of Neutropenic Patients. Patients hospitalized for aSCT as well as patients receiving treatment for AML were included in the analysis. Risk factor analysis for the occurrence of CDI was performed by backward-stepwise logistic regression (P < .1). During the period from January 2007 to August 2010, 310 hospitalizations of 152 patients with AML and 229 hospitalizations of 223 patients undergoing aSCT were eligible for analysis. Incidence rates for CDI per 10,000 patient days were 17.9 for AML patients and 27.4 for aSCT recipients. Among AML and aSCT patients, median time from initiation of chemotherapy to CDI was 10 days (range, -8 to 101 days) and 17 days (range, 6 to 79), respectively. Logistic regression identified carbapenem exposure to be associated with development of CDI in AML patients (odds ratio [OR], 2.2) and aSCT recipients (OR, 1.4). In both groups, previous exposure to carbapenems was significantly associated with development of CDI. A follow-up study, assessing the effect of an antibiotic stewardship intervention to decrease the administration of carbapenems in hematological high-risk patients, is warranted.
authors.affiliation: First Department of Internal Medicine, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner site Bonn-Cologne, Germany. Electronic address: maria.vehreschild@ctuc.de.
authors.forename: Maria J G T
authors.initials: MJ
authors.lastname: Vehreschild
authors.affiliation: First Department of Internal Medicine, University of Cologne, Cologne, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Weitershagen
authors.affiliation: First Department of Internal Medicine, University of Cologne, Cologne, Germany.
authors.forename: Lena M
authors.initials: LM
authors.lastname: Biehl
authors.affiliation: First Department of Internal Medicine, University of Cologne, Cologne, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Tacke
authors.affiliation: Department of Gastroenterology and Hepatology at Abdominal Center, University of Cologne, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Waldschmidt
authors.affiliation: Department of Gastroenterology and Hepatology at Abdominal Center, University of Cologne, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Töx
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Germany.
authors.forename: Hilmar
authors.initials: H
authors.lastname: Wisplinghoff
authors.affiliation: First Department of Internal Medicine, University of Cologne, Cologne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Von Bergwelt-Baildon
authors.affiliation: First Department of Internal Medicine, University of Cologne, Cologne, Germany; Clinical Trials Centre Cologne, ZKS Köln (BMBF 01KN1106), University of Cologne, Cologne, Germany; Center for Integrated Oncology CIO KölnBonn, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases CECAD, University of Cologne, Cologne, Germany.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
authors.affiliation: First Department of Internal Medicine, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner site Bonn-Cologne, Germany.
authors.forename: Joerg J
authors.initials: JJ
authors.lastname: Vehreschild
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005858:Germany / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000592:standards*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology* / Q000382:microbiology*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods / Q000592:standards; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: Acute myelogenous leukemia; Allogeneic stem cell transplantation; Carbapenem; Clostridium difficile infection