Relationship between Clostridioides Difficile Infections and Antimicrobial Use in Patients with Hematopoietic...

Objective To clarify the impact of the continued use of broad-spectrum antibiotics on the cure and relapse rates of Clostridioides difficile infection (CDI) in patients with hematopoietic diseases. Methods In this retrospective cohort study, we evaluated 84 patients with hematopoietic disease who were diagnosed with CDI at Nippon Medical School Hospital between 2011 and 2023. Patients Patients with insufficient observation (<60 days) or no treatment were excluded from the study. Patients were categorized into sufficient (≥10 days, n=62) or insufficient (<10 days, n=22) treatment groups, and into continuation (n=37) or discontinuation (n=25) groups based on broad-spectrum antibiotic use following CDI onset. The primary endpoints were CDI cure and relapse, while the secondary endpoints were relapse risk factors. Kaplan-Meier curves with competing risks were used for comparison. Results The median age of the patients was 64 years. The underlying diseases included acute myeloid leukemia (35.7%), lymphoma (36.9%), and others. Cure rates, relapse rates, and relapse-free survival did not differ significantly between the sufficient and insufficient treatment groups (93.5% vs. 100%, p=0.569; 33.9% vs. 31.8%, p=1; 172 days vs. 257 days, p=0.783). The outcomes were also comparable between the continuation and discontinuation groups (89.1% vs. 100%, p=0.141; 27.0% vs. 44.0%, p=0.184; 215 days vs. 157 days, p=0.132), despite the higher neutropenia prevalence in the continuation group (51.4% vs. 24.0%, p=0.038). No independent predictors of relapse were identified in this study. Conclusion In patients with hematopoietic diseases, the continuation of broad-spectrum antibiotics did not adversely influence CDI cure or relapse rates. These findings suggest that continuing antibiotics is acceptable when clinically indicated for immunocompromised populations.