Background
The frequency, risk factors, and outcomes for Clostridioides difficile infection (CDI) in patients with newly diagnosed acute leukemia (AL) admitted for
induction therapy are unclear.
Methods
We studied 509 consecutive patients with AL admitted between 2006 and 2017 and conducted
a prospective C difficile surveillance and ribotyping analysis in a subset of these.
Results
The incidence of CDI was 2.2/1,000 inpatient days during induction, and CDI was rare
after discharge. CDI was highest in patients with acute myelogenous leukemia. A hospitalization
shortly before admission and administration of a greater number of antibiotics increased
the risk for CDI. No single class of antibiotics conveyed an increased risk. All cases
were successfully treated, and CDI was not associated with an increase in length of
stay, costs, or mortality. In a subgroup analysis, 16% of patients with acute myelogenous
leukemia and 4% with other leukemia types were colonized on admission. Colonization
was associated with a higher risk of CDI. Ribotyping of available isolates showed
27 different strain types with 014/020 and 027 being the most frequent.
Conclusions
The number of antibiotics administered are a major risk factor for CDI in patients
with AL. However, CDI appears to have minimal clinical impact in this population.
Key Words
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Article info
Publication history
Published online: November 22, 2018
Footnotes
Funding/support: This work was supported by a grant from the Intermountain Healthcare Medical and Research Foundation (grant no. 20600035); the Utah Cancer Registry is funded by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (contract no. HHSN261201300017I) and the United States Center for Disease Control and Prevention's National Program of Cancer Registries (cooperative agreement no. NU58DP0063200-01), with additional support from the Utah Department of Health and the University of Utah.
Conflicts of interest: B.K.L. received research support from Cubist/Merck and OpGen in support of projects unrelated to this study. B.K.L. is a member of an advisory board for Merck & Co. There are no other conflicts of interest or financial disclosures to report.
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© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
