Hematologic diseases: High risk of Clostridium difficile associated diarrhea

doi:10.3748/wjg.v20.i21.6602

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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

Table 1 Demographic characteristics and risk factors for Clostidirium difficile associated diarrhea of the study subjects n (%)

Characteristics	HD(n = 144)	NHD(n = 176)	P value
Male	84 (58.3)	102 (58.0)	0.90
Age (mean ± SD)	47.4 ± 17.2	65.2 ± 16.0	< 0.01
Body mass index (mean ± SD), kg/m²	22.4 ± 3.4	20.4 ± 7.1	< 0.01
Charlson score	2.3 ± 1.0	4.0 ± 2.5	< 0.01
WBC (mean ± SD)/mm³	3093.6 ± 3879.1	9160.0 ± 6252.1	< 0.01
ANC (mean ± SD)/mm³	2014.7 ± 3052.4	6843.2 ± 5473.9	<0.01
Neutropenia	67 (46.5)	4 (2.3)	<0.01
Total hospital days within 60 d	22.2 ± 13.9	23.1 ± 17.0	0.62
Previous anti-cancer chemotherapy	139 (96.5)	60 (34.1)	< 0.01
Antibiotics
Use of antibiotics	142 (98.6)	166 (94.3)	0.07
Number of antibiotics	4.0 ± 1.6	2.6 ± 1.6	< 0.01
Days of antibiotics	27.8 ± 15.7	17.3 ± 13.9	< 0.01
Concomitant medications
Anti-fungal agents	111 (77.1)	21 (11.9)	< 0.01
Acyclovir, ganciclovir	44 (31.7)	7 (4.0)	< 0.01
Proton pump inhibitor	62 (43.1)	56 (31.8)	0.04
H2 antagonist	71 (51.1)	91 (45.3)	0.67
Toxin assay			0.30
Toxin A + B	111 (77.1)	132 (75.0)
Toxin B	26 (18.1)	40 (22.7)
Toxin A + B + binary toxin	7 (4.9)	4 (2.3)
Pseudomembranous colitis	7/31 (22.6)	16/32 (50)	0.02

CDAD: Clostidirium difficile associated diarrhea; HD: Hematologic disease; NHD: Nonhematologic disease.

Table 2 Antibiotic use of the study subjects n (%)

Antibiotics	HD(n =144)	NHD(n =176)	P value
Cephalosporin	128 (88.9)	119 (67.6)	< 0.01
Aminoglycoside	96 (66.7)	34 (19.3)	< 0.01
Quinolone	99 (68.9)	63 (35.8)	< 0.01
Carbapenem	58 (40.3)	39 (22.2)	< 0.01
Glycopeptide	43 (29.9)	47 (26.7)	0.53
β lactam/β lactamase inhibitor	40 (27.8)	82 (46.6)	< 0.01
TMP/SMX	30 (20.8)	9 (5.1)	< 0.01
Macrolide	16 (11.1)	19 (10.8)	0.93

HD: Hematologic disease; NHD: Nonhematologic disease; TMP/SMX, Trimethoprim/sulfamethoxazole.

Table 3 Treatment and clinical course of the study subjects n (%)

Characteristics	HD(n =144)	NHD(n =176)	P value
Treatment			0.82
Cessation of causative antibiotics for CDAD	42 (29.2)	57 (32.4)
Metronidazole	95 (66.0)	111 (63.1)
Oral vancomycin	7 (4.9)	8 (4.5)
Additional use of causative antibiotics for CDAD	109 (75.7)	79 (44.9)	< 0.01
Continuous use	67 (46.5)	22 (12.5)
Re-use	42 (29.2)	57 (32.4)
Concomitant use of IVIG	80 (55.6)	11 (6.3)	< 0.01
Severe CDAD	11 (7.6)	43 (24.4)	< 0.01
Leukocytosis	3 (2.1)	18 (10.2)	< 0.01
Hypoalbuminemia	5 (3.5)	31 (17.6)	< 0.01
AKI	3 (2.1)	11 (6.3)	0.10
Clinical outcome
Overall mortality within 1 mo	23 (16.0)	29 (16.5)	0.90
Mortality due to CDAD within 1 mo	1 (0.7)	1 (0.6)	0.89
Recurrence	27 (18.8)	15 (8.5)	< 0.01

HD: Hematologic disease; NHD: Nonhematologic disease; CDAD: CDAD: Clostidirium difficile associated diarrhea; IVIG: Intravenous immunoglobulin; AKI: Acute kidney injury.

Table 4 Comparison of recurrent vs non-recurrent Clostidirium difficile associated diarrhea in the hematologic disease group n (%)

Characteristics	Recurrent	Single episode	Univariate analysis	Multivariate analysis
	n =27	n =117	P value	P value	Odds ratio (95%CI)
Male	13 (48.1)	71 (60.7)	0.23
Age (mean ± SD)	47.5 ± 16.0	47.3 ± 17.6	0.93
Body mass index (mean ± SD), kg/m²	22.3 ± 3.6	22.4 ± 3.4	0.87
Total hospital days within 60 d	24.3 ± 12.9	21.8 ± 14.1	0.89
Charlson score	2.5 ± 1.7	2.2 ± 0.8	0.13
Antibiotics
Use of antibiotics	27 (100)	115 (98.3)	0.49
Number of antibiotics	4.2 ± 1.4	4.0 ± 1.7	0.57
Duration of antibiotics	27.8 ± 13.3	27.8 ± 16.2	1.0
WBC (mean ± SD)/mm³	1326.7 ± 1813.7	3501.4 ± 4113.1	< 0.01	0.50	1.0 (0.998-1.003)
ANC (mean ± SD)/mm³	751.1 ± 1224.5	2306.2 ± 3269.9	0.02	0.83	1.0 (0.997-1.002)
Neutropenia	17 (63.0)	50 (42.7)	0.04	0.87	1.13 (0.37-4.74)
Severe CDAD	2 (7.4)	9 (7.7)	1.0
Toxin assay
Toxin A + B	26 (96.2)	85 (72.6)	< 0.01	0.87	0.82 (0.8-8.8)
Toxin B	0 (0.0)	26 (22.2)	< 0.01	1.00	0
Toxin A + B + binary toxin	1 (3.7)	6 (5.1)	1.0
Treatment for CDAD			0.68
Metronidazole or vancomycin	20 (74.1)	82 (70.1)
Discontinuation of causative antibiotics	7 (25.9)	35 (29.9)
IVIG	8 (29.6)	72 (61.5)	< 0.01	< 0.01	0.24 (0.09-0.65)
Additional use of causative antibiotics for CDAD	27 (100.0)	82 (70.1)	< 0.01	1.00	0
Continuous use	20 (74.1)	47 (40.2)
Re-use	7 (25.9)	35 (29.9)

CDAD: Clostidirium difficile associated diarrhea; WBC: White blood cell; ANC: Absolute neutrophil count; IVIG: Intravenous immunoglobulin.

Citation: Gweon TG, Choi MG, Baeg MK, Lim CH, Park JM, Lee IS, Kim SW, Lee DG, Park YJ, Lee JW. Hematologic diseases: High risk of Clostridium difficile associated diarrhea. World J Gastroenterol 2014; 20(21): 6602-6607
URL: https://www.wjgnet.com/1007-9327/full/v20/i21/6602.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i21.6602