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Leukemia patients at greater risk for C. difficile
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Leukemia patients have a 2.6-fold higher risk for acquiring Clostridium difficile while in the hospital compared to those admitted for other reasons, according to a study published in Infection Control and Hospital Epidemiology.
“Leukemia itself was found to be independently associated with [C. difficile], which predicts a higher health care burden and higher costs,” Ruihong Luo, MD, PhD, of the University of Nevada School of Medicine, and colleagues wrote. “By independently increasing the risk of mortality in hospitalized leukemia patients, [C. difficile]serves as a negative prognostic factor on oncology wards.”
In the retrospective cohort study, researchers used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2005 to 2011 to identify more than 1.2 million cases with a primary discharge diagnosis of leukemia. Of these, 42,438 cases also had C. difficile, for an overall incidence rate of 3.4%. This was significantly greater than the incidence of infection in all hospital patients (0.85%), according to the researchers. This represented a 16.7% increase in C. difficile among leukemia patients during the course of the study.
In multivariate analysis, factors significantly associated with C. difficile occurrence included: sepsis complications (OR = 1.83; 95% CI, 1.78-1.88), neutropenia (OR = 1.35; 95% CI, 1.31-1.38), bone marrow or stem cell transplantation (OR = 1.27; 95% CI, 1.22-1.32), renal failure (OR = 1.18; 95% CI, 1.09-1.28), male sex (OR = 1.14; 95% CI, 1.11-1.17) and prolonged length of stay (LOS).
In addition, C. difficile was associated with increased mortality among leukemia patients (OR = 1.17; 95% CI, 1.13-1.22), as well as 2.6 times prolonged LOS and higher hospital charges. Also associated with increased mortality were: sepsis (OR = 5.79; 95% CI, 5.69-5.9), pneumonia (OR = 2.14; 95% CI, 2.11-2.18), being aged older than 65 years (OR = 1.9; 95% CI, 1.86-1.94), and lymphoma (OR = 1.24; 95% CI, 1.19-1.3).
The most common leukemia types identified within the database were chronic lymphoid leukemia (CLL, 44.6%) and acute myeloid leukemia (AML, 32.5%). C. difficile incidence was highest in those with AML (4.7%), followed by acute lymphoid leukemia (3.9%), chronic myeloid leukemia (2.9%) and CLL (2.5%).
“Comparisons of [C. difficile] rates between acute and chronic leukemia have rarely been published,” the researchers wrote. “We found that acute leukemia had higher incidence of [C. difficile] than chronic leukemia. Exposure to antibiotics, use of certain chemotherapeutic agents, prolonged or repeat hospitalization, sustained neutropenia, and allogenic stem cell transplantation are all more common in patients with acute leukemia and may explain the higher risk of [C. difficile].”
The study had several limitations, according to the researchers, including the inability to adjust for the severity of underlying leukemia. – by David Jwanier
Disclosure: The researchers report no relevant financial disclosures.
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