Clostridioides (Clostridium) Difficile Infection in the First Year after Hematopoietic Stem Cell Transplantation: A...

Clostridioides difficile (C.difficile) is an important problem in those who have undergone hematopoietic stem cell transplantation (HSCT). There is very limited data about CDI in HSCT recipients from India. The aim of the study was to describe the incidence, clinical characteristics, diagnostic methods and therapy used for CDI in HSCT recipients.This was a retrospective study from a tertiary care center in India. Adult patients who underwent HSCT from January 2018 to December 2023 were included. A total of 300 patients were studied till one year after HSCT. The overall incidence of CDI was 17% (n = 51). The incidence was comparable in autologous and allogeneic HSCT recipients. The median time to develop CDI post HSCT was 11 days. A total of 45 patients were diagnosed on the basis of combined GDH antigen and toxin positivity. A PCR test was used in the remaining six. Twenty-six and 14 patients respectively were initially treated with oral vancomycin and teicoplanin monotherapy. The incidence of refractory CDI was lower in the teicoplanin group. Fecal Microbiota Transplantation (FMT) was performed in 7 patients, all of whom achieved clinical cure.This is the largest study from India on CDI in the setting of HSCT. Our study shows that CDI is seen commonly in the early post HSCT period. It shows that oral teicoplanin is a good therapeutic option and needs to be explored further in the form of randomized clinical trials. FMT, though challenging, is doable in our settings.