title: Risk factors associated with Clostridium difficile infection in adult oncology patients.
abstract: OBJECTIVE
  Clostridium difficile infection (CDI) prevention is particularly important for cancer patients, because diarrhea often results in dose reductions or delays of chemotherapy or radiotherapy. We conducted this study to better ascertain the incidence, susceptibility, and risk factors for CDI in cancer patients receiving chemotherapy at our hospital.
  
  
  METHODS
  We performed a retrospective study among adult cancer patients admitted at "12 de Octubre" University Hospital between January 2009 through April 2013 who were diagnosed with diarrhea. Inpatient data were available on hospital medical records. We screened by immunochromatography system detecting glutamate dehydrogenase antigen, and C. difficile toxins A and B. Later, a polymerase chain reaction for detecting toxin B gene was performed.
  
  
  RESULTS
  A total of 225 patients were included in the study, and 39 of them (17.3 %) were diagnosed with CDI. Type of tumor significantly differed between CDI patients, thus relative risk in each type of cancer was calculated after adjusting for age, antibiotic exposure, corticosteroid, and proton-pump inhibitor use. Patients with gastrointestinal tumors were less prone to CDI. Conversely, breast cancer patients have a greater predisposition to CDI. Antibiotic treatment was found to be associated with an increasing risk for CDI in breast cancer patients. Curiously, exposure to proton-pump inhibitors appeared protective in our cohort, except for lung cancer patients. However, we have not been able to find an association between a particular type of chemotherapy and CDI.
  
  
  CONCLUSIONS
  We underscore the urgent need for early recognition and diagnosis of CDI in cancer patients. Our findings indicate a probable association between antibiotic use and CDI incidence, at least in certain cancer, such as breast cancer.
authors.affiliation: Oncology Department, Hospital Universitario 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain.
authors.forename: Analia
authors.initials: A
authors.lastname: Rodríguez Garzotto
authors.forename: Antonio
authors.initials: A
authors.lastname: Mérida García
authors.forename: Nerea
authors.initials: N
authors.lastname: Muñoz Unceta
authors.forename: M Mar
authors.initials: MM
authors.lastname: Galera Lopez
authors.forename: M Ángeles
authors.initials: MÁ
authors.lastname: Orellana-Miguel
authors.forename: C Vanesa
authors.initials: CV
authors.lastname: Díaz-García
authors.forename: Susana
authors.initials: S
authors.lastname: Cortijo-Cascajares
authors.forename: Hernán
authors.initials: H
authors.lastname: Cortes-Funes
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Agulló-Ortuño
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003967:Diarrhea / Q000382:microbiology / Q000517:prevention & control; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000382:microbiology*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors