Clostridium difficile Infections amongst Patients with Haematological Malignancies: A Data Linkage Study.
OBJECTIVE
Identify risk factors for Clostridium difficile infection (CDI) and assess CDI outcomes among Australian patients with a haematological malignancy.


METHODS
A retrospective cohort study involving all patients admitted to hospitals in Western Australia with a haematological malignancy from July 2011 to June 2012. Hospital admission data were linked with all hospital investigated CDI case data. Potential risk factors were assessed by logistic regression. The risk of death within 60 and 90 days of CDI was assessed by Cox Proportional Hazards regression.


RESULTS
There were 2085 patients of whom 65 had at least one CDI. Twenty percent of CDI cases were either community-acquired, indeterminate source or had only single-day admissions in the 28 days prior to CDI. Using logistic regression, having acute lymphocytic leukaemia, neutropenia and having had bacterial pneumonia or another bacterial infection were associated with CDI. CDI was associated with an increased risk of death within 60 and 90 days post CDI, but only two deaths had CDI recorded as an antecedent factor. Ribotyping information was available for 33 of the 65 CDIs. There were 19 different ribotypes identified.


CONCLUSIONS
Neutropenia was strongly associated with CDI. While having CDI is a risk factor for death, in many cases it may not be a direct contributor to death but may reflect patients having higher morbidity. A wide variety of C. difficile ribotypes were found and community-acquired infection may be under-estimated in these patients.
School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
Linda A
http://orcid.org/0000-0001-8493-0974
LA
Selvey
School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, WA, Australia.
Claudia
C
Slimings
Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA Australia.|School of Medicine, University of Western Australia, Perth, WA, Australia.
David J L
DJ
Joske
School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, WA, Australia.|Department of Microbiology, PathWest Laboratory Medicine, Nedlands, WA, Australia.
Thomas V
TV
Riley
D000368:Aged; D001315:Australia; D016360:Clostridioides difficile / Q000302:isolation & purification / Q000472:pathogenicity; D003015:Clostridium Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D006761:Hospitals; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors