TY - JOUR
T1 - Clostridium difficile infection after adult autologous stem cell transplantation
T2 - A multicenter study of epidemiology and risk factors
AU - Alonso, Carolyn D.
AU - Dufresne, Simon F.
AU - Hanna, David B.
AU - Labbé, Annie Claude
AU - Treadway, Suzanne B.
AU - Neofytos, Dionissios
AU - Bélanger, Sylvie
AU - Huff, Carol Ann
AU - Laverdière, Michel
AU - Marr, Kieren A.
N1 - Funding Information:
Conflict of interest statement: K.A.M. has received research funding from Astellas , Merck , and Pfizer and has served on advisory boards for Astellas, Merck, Optimer, Pfizer, Prev AbR, and Novartis. D.N. has received research funding from Pfizer. M.L. has received research funding from Astellas, Merck, and Pfizer and has served on advisory boards for Astellas, Merck, and Pfizer. The other authors have no conflicts of interest to report.
Funding Information:
Financial disclosure: This work was supported by funding from the Pamela Cresson Tucker Scholarship (to C.D.A.) and the National Institute of Allergy and Infectious Diseases (grant T32 AI007291 , to C.D.A., and grant K24 AI085118 , to K.A.M.).
PY - 2013/10
Y1 - 2013/10
N2 - We sought to describe the epidemiology of Clostridium difficile infection (CDI) among adult recipients of autologous hematopoietic stem cell transplantation (auto-HSCT) within the first year after HSCT in centers with variable epidemiology of hypertoxigenic strains. A multicenter, retrospective nested case-control study was conducted among 873 auto-HSCT recipients at Johns Hopkins Hospital (JHH) and HÔpital Maisonneuve-Rosemont (HMR) between January 2003 and December 2008. Despite center differences in the prevalence of NAP-1 strains during the study period (21% to 43% at JHH versus 80% to 84% in HMR), the 1-year incidence of CDI was similar in the 2 hospitals (6.2% at JHH versus 5.7% at HMR). The median time to infection was 11days (interquartile range, 1 to 27days). In case-control analyses, grade ≥2 mucositis (odds ratio [OR], 3.00; P=02) and receipt of a fourth-generation cephalosporin (OR, 2.76; P=04) were identified as predictors for CDI. Mucositis was the strongest predictor of risk for CDI in multivariate analysis (adjusted OR, 2.77; P=03). CDI is a common and early complication of auto-HSCT. Treatment-related gastrointestinal mucosal damage, along with the potentially modifiable risk of antimicrobial exposure, influence the risk for CDI early after auto-HSCT.
AB - We sought to describe the epidemiology of Clostridium difficile infection (CDI) among adult recipients of autologous hematopoietic stem cell transplantation (auto-HSCT) within the first year after HSCT in centers with variable epidemiology of hypertoxigenic strains. A multicenter, retrospective nested case-control study was conducted among 873 auto-HSCT recipients at Johns Hopkins Hospital (JHH) and HÔpital Maisonneuve-Rosemont (HMR) between January 2003 and December 2008. Despite center differences in the prevalence of NAP-1 strains during the study period (21% to 43% at JHH versus 80% to 84% in HMR), the 1-year incidence of CDI was similar in the 2 hospitals (6.2% at JHH versus 5.7% at HMR). The median time to infection was 11days (interquartile range, 1 to 27days). In case-control analyses, grade ≥2 mucositis (odds ratio [OR], 3.00; P=02) and receipt of a fourth-generation cephalosporin (OR, 2.76; P=04) were identified as predictors for CDI. Mucositis was the strongest predictor of risk for CDI in multivariate analysis (adjusted OR, 2.77; P=03). CDI is a common and early complication of auto-HSCT. Treatment-related gastrointestinal mucosal damage, along with the potentially modifiable risk of antimicrobial exposure, influence the risk for CDI early after auto-HSCT.
KW - Antibiotics
KW - Clostridium difficile
KW - Mucositis
KW - NAP-1
KW - Stem cell transplantation
UR - http://www.scopus.com/inward/record.url?scp=84884190473&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84884190473&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2013.07.022
DO - 10.1016/j.bbmt.2013.07.022
M3 - Article
C2 - 23916741
AN - SCOPUS:84884190473
VL - 19
SP - 1502
EP - 1508
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
SN - 1083-8791
IS - 10
ER -