Retrospective Study
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World J Gastroenterol. Jun 7, 2014; 20(21): 6602-6607
Published online Jun 7, 2014. doi: 10.3748/wjg.v20.i21.6602
Hematologic diseases: High risk of Clostridium difficile associated diarrhea
Tae-Geun Gweon, Myung-Gyu Choi, Myong Ki Baeg, Chul-Hyun Lim, Jae Myung Park, In Seok Lee, Sang Woo Kim, Dong-Gun Lee, Yeon Joon Park, Jong Wook Lee
Tae-Geun Gweon, Myung-Gyu Choi, Myong Ki Baeg, Chul-Hyun Lim, Jae Myung Park, In Seok Lee, Sang Woo Kim, Division of Gastroenterology, Department of Internal Medicine, Seoul St Mary’s hospital, The Catholic University of Korea, College of Medicine, Seoul 137-701, South Korea
Dong-Gun Lee, Division of Infectious Diseases, Department of Internal Medicine, Seoul St Mary’s hospital, The Catholic University of Korea, College of Medicine, Seoul 137-701, South Korea
Yeon Joon Park, Department of Laboratory Medicine, Seoul St Mary’s hospital, The Catholic University of Korea, College of Medicine, Seoul 137-701, South Korea
Jong Wook Lee, Division of Hematologic Diseases, Department of Internal Medicine, Seoul St Mary’s hospital, The Catholic University of Korea, College of Medicine, Seoul 137-701, South Korea
Author contributions: Gweon TG, Choi MG and Lee DG designed the study; Gweon TG, Lim CH, Park YJ and Lee JW collected data; Gweon TG, Park JM, Lee IS and Kim SW analyzed the results of the statistical analysis; Gweon TG, Choi MG, Baeg MK and Lee DG wrote and edited the paper, and approved the final version.
Supported by Business of Globalization for Science and Technology funded by the Ministry of Education, Science and Technology, Seoul, South Korea, No. NRF-2011-0031644
Correspondence to: Myung-Gyu Choi, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Seoul St Mary’s hospital, The Catholic University of Korea, College of Medicine, Banpodaero 222 Seocho-Gu, Seoul, 137-701, South Korea. choim@catholic.ac.kr
Telephone: +82-2-22582083 Fax: +82-2-22582089
Received: December 18, 2013
Revised: January 30, 2014
Accepted: March 8, 2014
Published online: June 7, 2014
Processing time: 169 Days and 20.7 Hours
Abstract

AIM: To investigate the incidence and clinical outcome of Clostridium difficile (C. difficile) associated diarrhea (CDAD) in patients with hematologic disease.

METHODS: We retrospectively reviewed the medical records of patients who underwent C. difficile testing in a tertiary hospital in 2011. The incidence and risk factors for CDAD and its clinical course including recurrence and mortality were assessed in patients with hematologic disease and compared with those in patients with nonhematologic disease.

RESULTS: About 320 patients were diagnosed with CDAD (144 patients with hematologic disease; 176 with nonhematologic disease). The incidence of CDAD in patients with hematologic disease was estimated to be 36.7 cases/10000 patient hospital days, which was higher than the 5.4 cases/10000 patient hospital days in patients with nonhematologic disease. Recurrence of CDAD was more frequent in patients with hematologic disease compared to those with nonhematologic disease (18.8% vs 8.5%, P < 0.01), which was associated with higher re-use of causative antibiotics for CDAD. Mortality due to CDAD did not differ between the two groups. Multivariate analysis showed that intravenous immunoglobulin was the only significant factor associated with a lower rate of recurrence of CDAD in patients with hematologic disease.

CONCLUSION: The incidence and recurrence of CDAD was higher in patients with hematologic disease than in those with nonhematologic disease.

Keywords: Clostridium difficile associated diarrhea; Incidence; Clinical outcome; Patients with hematologic disease; Intravenous immunoglobulin

Core tip: Our study included a large number of Clostridium difficile associated diarrhea (CDAD) patients at a dedicated hematopoietic stem cell transplantation center, which is one of the most renown centers for the treatment of hematologic diseases. The incidence and recurrence of CDAD was higher in patients with hematologic disease than in those with nonhematologic disease. This might be related to higher use of antibiotics. Use of intravenous immunoglobulin was associated with a lower CDAD recurrence rate. Based on our data, we suggest that physicians should be more aware of the higher incidence and rate of recurrence of CDAD in patients with hematologic disease.