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A case-control study of Clostridioides difficile symptomatic infections in a pediatric cancer hospital
Adriana Maria Paixão de Sousa da Silva1, Lara de Castro Barbosa2, Leticia Maria Acioli Marques3
1Instituto de Oncologia Pediátrica, São Paulo, SP, Brazil.
Insights
Clostridioides difficile infections in pediatric cancer patients are linked to prior antibiotic use and chemotherapy. Specific antibiotics like vancomycin and chemotherapy agents such as melphalan increase infection risk.
Area of Science:
- Infectious Diseases
- Pediatric Oncology
- Microbiology
Background:
- Clostridioides difficile infection (CDI) is a significant concern in immunocompromised patients.
- Identifying risk factors for CDI in children with cancer is crucial for prevention and management.
Purpose of the Study:
- To analyze documented CDI cases in pediatric cancer patients.
- To identify potential risk factors associated with CDI in this vulnerable population.
Main Methods:
- A retrospective case-control study was conducted from 2016-2019.
- Cases of CDI were matched with controls by age and underlying disease.
- Logistic regression models were employed to determine risk factors.
Main Results:
- 63 CDI cases and 125 controls were analyzed.
- Prior use of vancomycin, meropenem, and cefepime were significant risk factors (ORs 5.4, 4.41, 2.6 respectively).
- Chemotherapy agents including melphalan, busulfan, and asparaginase showed increased odds of CDI (ORs 9.04, 16.7, 8.97 respectively).
Conclusions:
- Symptomatic CDI in pediatric cancer patients is associated with prior hospitalization and antibiotic exposure.
- Specific chemotherapy drugs are identified as risk factors for CDI.
- Targeted preventive strategies are needed for high-risk cancer patients.
Objective:
The aim of this study was to analyze and identify documented infections and possible risk factors for Clostridioides difficile infections in children with cancer.
Methods:
This is a retrospective case-control study, carried out in a pediatric cancer hospital, covering the years 2016-2019. Matching was performed by age and underlying disease, and for each case, the number of controls varied from 1 to 3. Logistic regression models were used to assess risk factors.
Results:
We analyzed 63 cases of documented infection by C. difficile and 125 controls. Diarrhea was present in all cases, accompanied by fever higher than 38°C in 52.4% of the patients. Mortality was similar among cases (n=4; 6.3%) and controls (n=6; 4.8%; p=0.7). In all, 71% of patients in the case group and 53% in the control group received broad-spectrum antibiotics prior to the infection. For previous use of vancomycin, the Odds Ratio for C. difficile infection was 5.4 (95% confidence interval [95%CI] 2.3-12.5); for meropenem, 4.41 (95%CI 2.1-9.2); and for cefepime, 2.6 (95%CI 1.3-5.1). For the antineoplastic agents, the Odds Ratio for carboplatin was 2.7 (95%CI 1.2-6.2), melphalan 9.04 (95%CI 1.9-42.3), busulfan 16.7 (95%CI 2.1-134.9), and asparaginase 8.97 (95%CI 1.9-42.9).
Conclusions:
C. difficile symptomatic infection in children with cancer was associated with previous hospitalization and the use of common antibiotics in cancer patients, such as vancomycin, meropenem, and cefepime, in the last 3 months. Chemotherapy drugs, such as carboplatin, melphalan, busulfan, and asparaginase, were also risk factors.
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