title: Clostridium difficile carriage in hospitalized cancer patients: a prospective investigation in eastern China.
abstract: BACKGROUND
  Clostridium difficile carriage has been considered as a potential source for the deadly infection, but its role in cancer patients is still unclear. We aimed to identify the clinical and immunological factors that are related to C. difficile carriage in Chinese cancer patients.
  
  
  METHODS
  A total of 400 stool samples were collected from cancer patients who received chemotherapy in three hospitals of eastern China. Bacterial genomic DNA was extracted and two toxin genes (tcdA and tcdB) were detected. PCR ribotyping was performed using capillary gel electrophoresis. Concentrations of prostaglandin E2 (PGE2), transforming growth factor beta (TGF-β) and interleukin-10 (IL-10) were measured using enzyme-linked immunosorbent assay (ELISA) kits.
  
  
  RESULTS
  Eighty-two (20.5%) samples were confirmed to be C. difficile-positive and positive for tpi, tcdA, and tcdB genes. The C. difficile-positive rates in patients with diarrhea and no diarrhea were 35% and 19.7%, respectively (p = 0.09). Patients who were younger than 50 years old and were hospitalized for at least 10 days had a C. difficile-positive rate as high as 35%. In contrast, patients who were older than 50 years old and were hospitalized for less than 10 days had a C. difficile-positive rate of only 12.7% (p = 0.0009). No association was found between C. difficile carriage and chemotherapy regimen, antibiotic drug use, or immunosuppressive mediators, such as prostaglandin E2 (PGE2), transforming growth factor beta (TGF-β), or interleukin-10 (IL-10). Twelve ribotypes of C. difficile were identified, but none of them belonged to ribotype 027.
  
  
  CONCLUSIONS
  We conclude that younger patients and those with longer hospitalization stays may be more prone to C. difficile carriage. Studies of larger populations are warranted to clarify the exact role of C. difficile carriage in hospitalized cancer patients in China.
authors.forename: Wei-Jia
authors.initials: WJ
authors.lastname: Fang
authors.forename: Da-Zhi
authors.initials: DZ
authors.lastname: Jing
authors.forename: Yun
authors.initials: Y
authors.lastname: Luo
authors.forename: Cai-Yun
authors.initials: CY
authors.lastname: Fu
authors.forename: Peng
authors.initials: P
authors.lastname: Zhao
authors.forename: Jiong
authors.initials: J
authors.lastname: Qian
authors.forename: Bing-Ru
authors.initials: BR
authors.lastname: Tian
authors.forename: Xiao-Gang
authors.initials: XG
authors.lastname: Chen
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Zheng
authors.forename: Yi
authors.initials: Y
authors.lastname: Zheng
authors.forename: Jing
authors.initials: J
authors.lastname: Deng
authors.forename: Wei-Hua
authors.initials: WH
authors.lastname: Zou
authors.forename: Xue-Ren
authors.initials: XR
authors.lastname: Feng
authors.forename: Fan-Long
authors.initials: FL
authors.lastname: Liu
authors.forename: Xiao-Zhou
authors.initials: XZ
authors.lastname: Mou
authors.affiliation: First Affiliated Hospital, School of Medicine, ZheJiang University, 79 Qinchun Road, Hangzhou 310006, China. shusenzheng@zju.edu.cn.
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Zheng
mesh_terms: D001427:Bacterial Toxins / Q000235:genetics; D002353:Carrier State / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D002681:China; D016360:Clostridioides difficile / Q000235:genetics*; D004269:DNA, Bacterial / Q000235:genetics; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006760:Hospitalization; D006801:Humans; D016753:Interleukin-10 / Q000235:genetics; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D009369:Neoplasms / Q000453:epidemiology* / Q000382:microbiology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D021521:Ribotyping
chemical_list: D001427:Bacterial Toxins; D004269:DNA, Bacterial; D016753:Interleukin-10