C. difficile infection prevalent among stem cell transplant patients

Researchers from Johns Hopkins found that an increased incidence of Clostridium difficile infections was detected among patients who underwent hematopoietic stem cell transplants.

"The disease occurs relatively early in both allogeneic and autologous hematopoietic stem cell transplant recipients," Carolyn Alonso, MD, of the department of medicine at Johns Hopkins University, told Infectious Disease News. "Risk factors are numerous and some are related to the pre-transplant condition of the patient. We're questioning whether there is a subset of people who develop the disease early because of pre-hematopoietic stem cell transplant colonization."

Alonso and colleagues performed a retrospective, nested, case-control study to determine the epidemiology, timing and risk factors for C. difficile infection among patients who received hematopoietic stem cell transplants.

They found that the overall 1-year incidence of C. difficile infection was 9.2%. The median time to C. difficile diagnosis after hematopoietic stem cell transplants was 6.5 days for autologous hematopoietic stem cell transplants and 33 days for allogeneic hematopoietic stem cell transplants.

Primary risk factors for C. difficile infection included receipt of chemotherapy before hematopoietic stem cell transplant, the use of broad-spectrum antimicrobials and acute graft-versus-host disease (GVHD). The researchers found a significant relationship between early C. difficile infection and development of GVHD in the gastrointestinal track in the year after allogeneic hematopoietic stem cell transplant. Lastly, gastrointestinal GVHD was associated with an increased risk for recurrent C. difficile infection.

"These findings are significant because this represents one of the largest studies of C. difficile infection in stem cell transplant patients and underscores that this is a vulnverable and highly affected population," Alonso said. "Future epidemiologic studies and disease prevention studies will need to include this growing patient population. Infectious disease specialists should consider C. difficile infection to be one of the important, early infectious complications of stem cell transplantation and should consider testing for it when patients develop diarrheal symptoms during the transplant course."

References:

• Alonso CD. Clin Infect Dis. 2012;54:1053-1063.

Disclosures: Some of the researchers report financial relationships with Astellas, BD Diagnostics, Merck, NanoMR, Novartis, Optimer, Pfizer, Prev AbR and Quidel.