title: [Risk factors for Clostridium difficile-associated diarrhea among cancer patients].
abstract: OBJECTIVE
  The aim of this study was to investigate the prevalence of Clostridium difficile (C. difficile) infection and the risk factors for acquisition of C. difficile-associated diarrhea (CDAD) among cancer patients who received chemotherapy or radiation therapy.
  
  
  METHODS
  We analyzed 277 stool samples from cancer patients with diarrhea between Sep 2010 and Dec 2011 in our hospital. Stool C. difficile toxin A/B test, stool culture for C. difficile and routine stool examination were performed. In addition, the risk factors for CDAD were investigated in a set of 41 C. difficile toxin-positive cancer patients and 82 matched C. difficile toxin-negative controls by univariate analysis and multivariate analysis.
  
  
  RESULTS
  Out of a total of 277 cancer patients with diarrhea, 41 (14.8%) were C. difficile toxin-positive. Among these 41 cases, 11 (26.8%, 11/41) were C. difficile culture-positive. Univariate analysis showed that antibiotics use (P = 0.853), proton pump inhibitor use (P = 0.718), hypoproteinemia (P = 0.139) and white blood cell count (P = 0.454) did not appear to be associated with acquisition of CDAD in cancer patients. However, receiving chemotherapy (P = 0.023), receiving radiotherapy (P = 0.003), a positive fecal occult blood test result (P = 0.005) and the presence of fecal leukocytes (P = 0.007) showed close association with acquisition of CDAD in cancer patients. Multivariate analysis showed that receiving chemotherapy (OR, 8.308; 95% CI, 1.997-34.572; P = 0.004) and a positive result of fecal occult blood test (OR, 8.475; 95% CI, 1.463-49.109; P = 0.017) were independent risk factors for acquisition of CDAD among cancer patients.
  
  
  CONCLUSIONS
  Our results support that receiving chemotherapy and a positive fecal occult blood test result are independent risk factors for acquisition of CDAD among cancer patients. Cancer patients who are at high-risk for CDAD should take stool C. difficile toxin A/B test and stool culture for C. difficile regularly and prevention of CDAD.
authors.affiliation: Department of Clinical Laboratory, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhu
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Shana
authors.initials: S
authors.lastname: Feng
authors.forename: Shuai
authors.initials: S
authors.lastname: Wang
authors.forename: Cuiling
authors.initials: C
authors.lastname: Zheng
authors.forename: Jingzhi
authors.initials: J
authors.lastname: Wang
authors.forename: Chunxia
authors.initials: C
authors.lastname: Du
authors.forename: Yun
authors.initials: Y
authors.lastname: Feng
authors.forename: Dan
authors.initials: D
authors.lastname: Li
authors.affiliation: Email: syuankai@cicams.ac.cn.
authors.forename: Yuankai
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Email: hanxh@cicams.ac.cn.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Han
mesh_terms: D016360:Clostridioides difficile; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology*; D006801:Humans; D009369:Neoplasms / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors