title: Incidence of diarrhea by Clostridium difficile in hematologic patients and hematopoietic stem cell transplantation patients: risk factors for severe forms and death.
abstract: We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematologic and patients undergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011, using two denominators 1,000 patient and 1,000 days of neutropenia and the risk factors associated with the severe form of the disease and death. The ELISA method (Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identify C. difficile. A multivariate analysis was performed to evaluate potential factors associated with severe CDAD and death within 14 days after the diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were identified in 64 patients among 439 patients with diarrhea during the study period. CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from 0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute myeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (45%) undergone allogeneic HSCT, 61/64 (88%) had previously used antibiotics and 9/64 (13%) have severe CDAD. Most of the patients (89%) received treatment with oral metronidazole and 19/64 (26%) died. The independent risk factors associated with death were the severe form of CDAD, and use of linezolid.
authors: Hospital das Clinicas, University of São Paulo, São Paulo, SP, Brazil.
authors: Fernanda
authors: F
authors: Spadão
authors: Hospital das Clinicas, University of São Paulo, São Paulo, SP, Brazil.
authors: Juliana
authors: J
authors: Gerhardt
authors: Hospital das Clinicas, University of São Paulo, São Paulo, SP, Brazil.
authors: Thais
authors: T
authors: Guimarães
authors: Hospital das Clinicas, Bone Marrow Transplant Unit, University of São Paulo, São Paulo, SP, Brazil.
authors: Frederico
authors: F
authors: Dulley
authors: Laboratory of Microbiology, Hospital das Clinicas of University, São Paulo, São Paulo, SP, Brazil.
authors: João Nóbrega de
authors: JN
authors: Almeida Junior
authors: Infectious Diseases Department, Unversity of São Paulo, Brazil.
authors: Marjorie Vieira
authors: MV
authors: Batista
authors: Infectious Diseases Department, Unversity of São Paulo, Brazil.
authors: Maria Aparecida
authors: MA
authors: Shikanai-Yasuda
authors: Infectious Diseases Department, Unversity of São Paulo, Brazil.
authors: Anna Sara
authors: AS
authors: Levin
authors: Infectious Diseases Department, Unversity of São Paulo, Brazil.
authors: Silvia Figueiredo
authors: SF
authors: Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D016360:Clostridioides difficile; D003967:Diarrhea / Q000401:mortality*; D004761:Enterocolitis, Pseudomembranous / Q000401:mortality*; D005260:Female; D006402:Hematologic Diseases; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult