CDI more prevalent in allogeneic vs. autologous stem cell recipients

Clostridium difficile infection, or CDI, was more prevalent in patients undergoing allogeneic stem cell transplantation compared with patients undergoing autologous stem cell transplantation, according to findings published in Infection Control and Hospital Epidemiology.

CDI was significantly associated with longer hospital stays, septicemia and more frequently occurred in men for both types of patients.

“CDI is the most common cause of infectious diarrhea in hospitalized patients,” Nishi N. Shah, MD, MPH, resident at the University of Arkansas for Medical Sciences, and colleagues wrote. “Epidemiological studies evaluating the incidence of and morbidity and mortality due to CDI in hematopoietic stem cell transplant recipients are limited.”

The researchers reviewed patient data from the National Inpatient Sample database, analyzing records of adults admitted for allogeneic stem cell transplantation (n = 33,189) and autologous stem cell transplantation (n = 53,072) between January 2001 and December 2010.

Most patients had received autologous stem cell transplantation (61.5%). Of patients in the allogeneic group, 8.5% had CDI, compared with 5.8% in the autologous group, the researchers reported. Shah and colleagues wrote that univariate analyses identified several risk factors for CDI, including: age, gender, indication for stem cell transplantation, radiation as part of the conditioning regimen, respiratory failure, septicemia and lengthy hospital stay. Multivariate analyses for autologous transplantation showed significant correlation between age and indication for transplant, but the indication was not associated with CDI in either group.

The researchers found multiple factors associated with C. difficile infection, including septicemia (autologous OR = 1.64; 95% CI, 1.35-2; allogeneic OR = 1.69; 95% CI, 1.36-2.1), male gender (autologous OR = 1.29; 95% CI, 1.09-1.53; allogeneic OR = 1.36; 95% CI, 1.18-1.57), lengthy hospital stay (autologous OR = 2.81; 95% CI, 2.29-3.45; allogeneic OR = 2.63; 95% CI, 2.15-3.22) and presence of multiple comorbidities (autologous OR = 1.32; 95% CI, 1.11-1.57; allogeneic OR = 1.18; 95% CI, 1-1.4).

The researchers noted that the “mainstays of CDI prevention” include antimicrobial stewardship and infection control practices, such as barrier precautions and environmental cleaning. However, CDI rates remain elevated, they said, suggesting alternative strategies are needed.

“The current study helps identify higher risk groups for such clinical interventions. Among allogeneic stem cell transplantation recipients, interventions to reduce or treat gut GVHD could also impact C. difficile infection rates,” the researchers wrote. “Many topics of study remain to be explored in the prevention of C. difficile infection among stem cell transplantation patients. Certainly, further interventions to improve outcomes, such as reducing the rate of C. difficile infection, are needed.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.