title: Risk factors and impact of Clostridium difficile recurrence on haematology patients.
abstract: The incidence of Clostridium difficile infection (CDI) in adults with malignancy is 7%-14% compared with 1%-2% in the general hospitalized population. Despite the increased incidence of CDI in this population, a major concern is the propensity of CDI to recur, leading to delays in therapy impacting outcomes. We conducted a retrospective case-control study to identify risk factors for recurrent CDI (rCDI) and to determine the impact of rCDI on adult patients with a haematological malignancy.
  
  
  
  Adult haematology patients with CDI from June 2010 to December 2014 were divided into two groups: rCDI and non-rCDI. Multivariable models using logistic regression were constructed to identify risk factors for rCDI.
  
  
  
  A total of 100 patients in our study yielded a 41% recurrence rate. CDI impacted chemotherapy significantly more in the rCDI group (53.7% versus 11.9%, P  <0.001), primarily due to interruptions in established treatment plans (46.3% versus 10.3%, P  <0.001). Risk factors for rCDI identified at index included salvage lymphoma chemotherapy (OR 9.64, 95% CI 1.02-91.15, P  = 0.048) and severe CDI (OR 4.82, 95% CI 1.31-17.66, P  = 0.018). Longitudinal risk factors included exposure to fluoroquinolones (OR 3.96, 95% CI 1.04-15.15, P  = 0.044), ceftriaxone (OR 18.93, 95% CI 1.27-281.95, P  = 0.033) and piperacillin/tazobactam (OR 10.4, 95% CI 1.81-59.64, P  = 0.009).
  
  
  
  Haematology patients exhibit a higher rate of rCDI than general hospitalized patients. Utilization of this multivariable model to guide index CDI therapy at index may help to decrease the rCDI and prevent delays or interruptions in chemotherapy.
authors.affiliation: Department of Pharmacy Services and Clinical Sciences, University of Michigan Health System and College of Pharmacy, Ann Arbor, MI, USA.
authors.forename: Gianni B
authors.initials: GB
authors.lastname: Scappaticci
authors.affiliation: Department of Pharmacy Services and Clinical Sciences, University of Michigan Health System and College of Pharmacy, Ann Arbor, MI, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perissinotti
authors.affiliation: Department of Pharmacy Services and Clinical Sciences, University of Michigan Health System and College of Pharmacy, Ann Arbor, MI, USA.
authors.forename: Jerod L
authors.initials: JL
authors.lastname: Nagel
authors.affiliation: Department of Internal Medicine, Division of Haematology and Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Dale L
authors.initials: DL
authors.lastname: Bixby
authors.affiliation: Department of Pharmacy Services and Clinical Sciences, University of Michigan Health System and College of Pharmacy, Ann Arbor, MI, USA.
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Marini
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors