Basic Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Oct 10, 2017; 8(5): 398-404
Published online Oct 10, 2017. doi: 10.5306/wjco.v8.i5.398
Characteristics of Clostridium difficile infection in patients hospitalized with myelodysplastic syndrome or acute myelogenous leukemia
Kamini Shah, Bryan F Curtin, Christopher Chu, Daniel Hwang, Mark H Flasar, Erik von Rosenvinge
Kamini Shah, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Bryan F Curtin, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 21201, United States
Christopher Chu, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Daniel Hwang, Department of Medicine, University of Maryland School of Medicine, Baltimore 21201, MD, United States
Mark H Flasar, Erik von Rosenvinge, Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine and VA Maryland Health Care System, Baltimore, MD 21201, United States
Author contributions: Shah K and Curtin BF collected data and wrote the manuscript; Chu C and Hwang D collected data; Flasar MH analyzed and interpreted the data; von Rosenvinge E supervised the study; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the University of Maryland, Baltimore (IRB# HP-00058296).
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: Data set is available from the corresponding author at evonrose@medicine.umaryland.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Erik von Rosenvinge, MD, Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine and VA Maryland Health Care System, Baltimore, MD 21201, United States. evonrose@medicine.umaryland.edu
Telephone: +1-410-6057000 Fax: +1-410-3288315
Received: March 11, 2017
Peer-review started: March 23, 2017
First decision: May 5, 2017
Revised: July 6, 2017
Accepted: July 14, 2017
Article in press: July 17, 2017
Published online: October 10, 2017
Abstract
AIM

To evaluate factors associated with Clostridium difficile infection (CDI) and outcomes of CDI in the myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) population.

METHODS

After IRB approval, all MDS/AML patients hospitalized at the University of Maryland Greenebaum Comprehensive Cancer Center between August 2011 and December 2013 were identified. Medical charts were reviewed for demographics, clinical information, development of CDI, complications of CDI, and mortality. Patients with CDI, defined as having a positive stool PCR done for clinical suspicion of CDI, were compared to those without CDI in order to identify predictors of disease. A t-test was used for comparison of continuous variables and chi-square or Fisher’s exact tests were used for categorical variables, as appropriate.

RESULTS

Two hundred and twenty-three patients (60.1% male, mean age 61.3 years, 13% MDS, 87% AML) had 594 unique hospitalizations during the study period. Thirty-four patients (15.2%) were diagnosed with CDI. Factors significantly associated with CDI included lower albumin at time of hospitalization (P < 0.0001), prior diagnosis of CDI (P < 0.0001), receipt of cytarabine-based chemotherapy (P = 0.015), total days of neutropenia (P = 0.014), and total days of hospitalization (P = 0.005). Gender (P = 0.10), age (P = 0.77), proton-pump inhibitor use (P = 0.73), receipt of antibiotics (P = 0.66), and receipt of DNA hypomethylating agent-based chemotherapy (P = 0.92) were not significantly associated with CDI.

CONCLUSION

CDI is common in the MDS/AML population. Factors significantly associated with CDI in this population include low albumin, prior CDI, use of cytarabine-based chemotherapy, and prolonged neutropenia. In this study, we have identified a subset of patients in which prophylaxis studies could be targeted.

Keywords: Clostridium difficile, Acute myeloid leukemia, Cytarabine-based chemotherapy, Myelodysplastic syndrome, Neutropenia

Core tip: This study evaluates factors associated with the development and outcomes of Clostridium difficile infection (CDI) in patients with Myelodysplastic syndrome (MDS) or acute myelogenous leukemia (AML). Our findings demonstrate a high incidence of CDI with 15.2% of patients diagnosed with CDI during the 28-mo study period. Risk factors associated with the development of CDI include low albumin, prior history of CDI, chemotherapy within 30 d of hospitalization, cytarabine-based chemotherapy within 30 d of hospitalization, and increased duration of neutropenia and hospitalization.