Clostridium difficile infection after adult autologous stem cell transplantation: A multicenter study of epidemiology and risk factors

Carolyn D. Alonso, Simon F. Dufresne, David B. Hanna, Annie Claude Labbé, Suzanne B. Treadway, Dionissios Neofytos, Sylvie Bélanger, Carol Ann Huff, Michel Laverdière, Kieren A. Marr

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1502-1508
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number10
DOIs
StatePublished - Oct 2013

Fingerprint

Clostridium Infections
Adult Stem Cells
Clostridium difficile
Stem Cell Transplantation
Multicenter Studies
Epidemiology
Hematopoietic Stem Cell Transplantation
Mucositis
Odds Ratio
Cephalosporins
Case-Control Studies
Multivariate Analysis
Incidence
Infection

Keywords

  • Antibiotics
  • Clostridium difficile
  • Mucositis
  • NAP-1
  • Stem cell transplantation

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Clostridium difficile infection after adult autologous stem cell transplantation : A multicenter study of epidemiology and risk factors. / Alonso, Carolyn D.; Dufresne, Simon F.; Hanna, David B.; Labbé, Annie Claude; Treadway, Suzanne B.; Neofytos, Dionissios; Bélanger, Sylvie; Huff, Carol Ann; Laverdière, Michel; Marr, Kieren A.

In: Biology of Blood and Marrow Transplantation, Vol. 19, No. 10, 10.2013, p. 1502-1508.

Research output: Contribution to journalArticle

Alonso, CD, Dufresne, SF, Hanna, DB, Labbé, AC, Treadway, SB, Neofytos, D, Bélanger, S, Huff, CA, Laverdière, M & Marr, KA 2013, 'Clostridium difficile infection after adult autologous stem cell transplantation: A multicenter study of epidemiology and risk factors', Biology of Blood and Marrow Transplantation, vol. 19, no. 10, pp. 1502-1508. https://doi.org/10.1016/j.bbmt.2013.07.022
Alonso, Carolyn D. ; Dufresne, Simon F. ; Hanna, David B. ; Labbé, Annie Claude ; Treadway, Suzanne B. ; Neofytos, Dionissios ; Bélanger, Sylvie ; Huff, Carol Ann ; Laverdière, Michel ; Marr, Kieren A. / Clostridium difficile infection after adult autologous stem cell transplantation : A multicenter study of epidemiology and risk factors. In: Biology of Blood and Marrow Transplantation. 2013 ; Vol. 19, No. 10. pp. 1502-1508.
@article{22e1cef6429841808677bf7b7c15298d,
title = "Clostridium difficile infection after adult autologous stem cell transplantation: A multicenter study of epidemiology and risk factors",
abstract = "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 H{\^O}pital 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.",
keywords = "Antibiotics, Clostridium difficile, Mucositis, NAP-1, Stem cell transplantation",
author = "Alonso, {Carolyn D.} and Dufresne, {Simon F.} and Hanna, {David B.} and Labb{\'e}, {Annie Claude} and Treadway, {Suzanne B.} and Dionissios Neofytos and Sylvie B{\'e}langer and Huff, {Carol Ann} and Michel Laverdi{\`e}re and Marr, {Kieren A.}",
year = "2013",
month = "10",
doi = "10.1016/j.bbmt.2013.07.022",
language = "English (US)",
volume = "19",
pages = "1502--1508",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
publisher = "Elsevier Inc.",
number = "10",

}

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.

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 -