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

S Mani1, L Rybicki2, D Jagadeesh3

  • 1Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.

Bone Marrow Transplantation
|January 5, 2016
PubMed

Insights

Hematopoietic stem cell transplant recipients face a high risk of Clostridium difficile infection (CDI). Prior antibiotic use, excluding CDI treatment, significantly increases the likelihood of recurrent CDI in these patients.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Transplantation Medicine

Background:

  • Clostridium difficile infection (CDI) is a major cause of hospital-acquired infections.
  • Hematopoietic stem cell transplantation (HSCT) patients have an elevated risk of CDI due to factors like prolonged hospitalization, immunosuppression, and antibiotic use.
  • Gut mucosal damage from GvHD also contributes to CDI risk in HSCT recipients.

Purpose of the Study:

  • To evaluate risk factors for recurrent CDI specifically in hematopoietic stem cell transplantation recipients.
  • To identify predictors of CDI recurrence in this vulnerable patient population.

Main Methods:

  • Retrospective analysis of 499 allogeneic HSCT recipients transplanted between 2005 and 2012.
  • Inclusion criteria: patients who developed CDI within 6 months pre-transplant or 2 years post-transplant.
  • Multivariable analyses were performed to identify significant risk factors for recurrence.

Main Results:

  • Of 499 HSCT recipients, 61 (12%) developed CDI.
  • Recurrent CDI occurred in 20 patients (33% of those with CDI), with a 1-year incidence of 31%.
  • The number of antecedent antibiotics (excluding those for CDI treatment) was the only significant risk factor for recurrence (HR 1.96, P=0.025).

Conclusions:

  • Antecedent antibiotic exposure is a key predictor of recurrent CDI in HSCT recipients.
  • Most recurrences happen within 6 months of the initial CDI.
  • Further research into secondary prophylaxis is needed to prevent CDI recurrence in this population.

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