Risk factors for recurrent Clostridium difficile infection in hematopoietic stem cell transplant recipients

Area of Science:

• Infectious Diseases
• Hematology
• Transplantation Medicine

Background:

• Recurrent Clostridium difficile infection (CDI) poses a significant challenge in healthcare, particularly for hematopoietic stem cell transplant (HSCT) recipients.
• Limited data exist on CDI recurrence rates and associated risk factors in the HSCT population.

Purpose of the Study:

• To evaluate CDI recurrence rates in HSCT patients.
• To identify risk factors associated with CDI recurrence in HSCT patients.
• To compare CDI recurrence rates between HSCT patients and other hospitalized patients.

Main Methods:

• A retrospective study of HSCT patients diagnosed with CDI between January 2010 and December 2012.
• Patients were categorized into non-recurrent CDI (nrCDI) and recurrent CDI (rCDI) groups.
• Risk factors for rCDI were compared, and recurrence rates were contrasted with those in other hospitalized patients.

Main Results:

• CDI occurred in 95 of 711 HSCT patients (22 rCDI, 73 nrCDI).
• Recurrence rates were comparable between HSCT patients (23.2%) and other hospitalized patients (22.9%).
• Patients with rCDI developed the index CDI earlier post-transplant (3.5 vs. 7.0 days).
• Neutropenia at the time of the index CDI case was the sole independent predictor of rCDI (OR=5.7, P=0.006).

Conclusions:

• The incidence of recurrent CDI is similar in HSCT recipients and general hospitalized patients.
• Most HSCT patients develop their initial CDI within one week of transplantation.
• Neutropenia during the initial CDI episode is a potential risk factor for recurrence in HSCT patients.