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 language | English (US) |
|---|---|
| Pages (from-to) | 1502-1508 |
| Number of pages | 7 |
| Journal | Biology of Blood and Marrow Transplantation |
| Volume | 19 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2013 |
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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 journal › Article
}
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 -