Blood Res.  2019 Jun;54(2):120-124. 10.5045/br.2019.54.2.120.

Determining the risk factors associated with the development of Clostridium difficile infection in patients with hematological diseases

• Lee-Tsai Y
• Luna-Santiago R
• Demichelis-Gómez R
• Ponce-de-León A
• Ochoa-Hein E
• Tamez-Torres KM
• Bourlon MT
• Bourlon C

• KMID: 2451012
• DOI: http://doi.org/10.5045/br.2019.54.2.120

Abstract

BACKGROUND
Clostridium difficile infection (CDI) is a nosocomial condition prevalent in patients with hematological disorders. We aimed to identify the risk factors associated with the development of CDI and assess the mortality rate at 15 and 30 days among hematologic patients admitted to a tertiary care center.
METHODS
We conducted a retrospective case-control study from January 2010 to December 2015. Forty-two patients with hematologic malignancy and CDI, and 84 with hematologic disease and without history of CDI were included in the case and control groups, respectively.
RESULTS
Univariate analysis revealed that episodes of febrile eutropenia [odds ratio (OR), 5.5; 95% confidence interval (CI), 2.3-12.9; P<0.001], admission to intensive care unit (OR, 3.8; 95% CI, 1.4-10.2; P=0.009), gastrointestinal surgery (OR, 1.2; 95% CI, 1.1-1.4; P<0.001), use of therapeutic (OR, 6.4; 95% CI, 2.5-15.9; P<0.001) and prophylactic antibiotics (OR, 4.2; 95% CI, 1.6-10.7; P=0.003) in the last 3 months, and >1 hospitalization (OR, 5.6; 95% CI, 2.5-12.6; P<0.001) were significant risk factors. Multivariate analysis showed that use of therapeutic antibiotics in the last 3 months (OR, 6.3; 95% CI, 2.1-18.8; P=0.001) and >1 hospitalization (OR, 4.3; 95% CI, 1.7-11.0; P=0.002) were independent risk factors. Three (7.1%) and 6 (14.2%) case patients died at 15 and 30 days, respectively.
CONCLUSION
The risk factors for developing CDI were exposure to therapeutic antibiotics and previous hospitalization. Hematological patients who developed CDI had higher early mortality rates, suggesting that new approaches for prevention and treatment are needed.

Keyword

Clostridium difficile; Hematologic diseases; Risk factors; Tertiary care centers

MeSH Terms

Anti-Bacterial Agents
Case-Control Studies
Clostridium difficile*
Clostridium*
Hematologic Diseases*
Hematologic Neoplasms
Hospitalization
Humans
Intensive Care Units
Mortality
Multivariate Analysis
Retrospective Studies
Risk Factors*
Tertiary Care Centers
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Overall survival of cases and controls at 15 and 30 days.

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