Clostridium difficile Infection: Associations with Chemotherapy, Radiation Therapy, and Targeting Therapy Treatments.
BACKGROUND
Although mucositis, diarrhea, and constipation as well as immunosuppression are well recognized side-effects of cancer treatment, the underlying mechanisms including changes in the composition of gut microbiota and Clostridium difficile infection have not yet been thoroughly reviewed.


OBJECTIVE
We herein set out to review the literature regarding the relations between cancer chemotherapy, radiation treatment, and Clostridium difficile-associated colitis.


METHODS
Review of the English language literature published from 2008 to 2015 on the association between cancer chemotherapy, radiation treatment, and C. difficile-associated colitis.


RESULTS
Certain chemotherapeutic combinations, mainly those containing paclitaxel, are more likely to be followed by C. difficile infection (CDI), while some tumor types are more likely to be complicated by CDI following chemotherapy. CDI following irradiation occurs mostly in patients who were treated for cancer in the head and neck area. Risk factors found were proton pump inhibitors, antibiotics, cytostatic agents, and tube feeding. The drug of choice for an initial episode of mild-to-moderate CDI is metronidazole, whereas vancomycin is reserved for an initial episode of severe CDI. Fidaxomycin is another option for treatment of severe CDI, with fewer recurrences.


CONCLUSIONS
The influence of CDI on the treatment of oncological patients is not fully acknowledged. Infection with C. difficile is more frequent in those patients treated by antibiotics simultaneously with chemotherapy. Aggressive supportive care with intravenous hydration, antibiotics, and close surgical monitoring for selective intervention can significantly decrease the morbidity and life-threatening complications associated with this infection.
Avi
A
Peretz
Baruch Padeh Medical Center & Faculty of Medicine in the Galilee, Bar Ilan University - Obstetrics & Gynecology, PORIYA M.P. Lower Galilee 15208, Tiberias 15208, Israel.
Izhar Ben
IB
Shlomo
Orna
O
Nitzan
Luigi
L
Bonavina
Pmela M
PM
Schaffer
Moshe
M
Schaffer
D000970:Antineoplastic Agents / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000187:drug effects* / Q000502:physiology*; D003015:Clostridium Infections / Q000139:chemically induced / Q000188:drug therapy* / Q000517:prevention & control / Q000532:radiotherapy*; D006801:Humans; D058990:Molecular Targeted Therapy / Q000379:methods*
D000970:Antineoplastic Agents