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

22 Scopus citations


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
Issue number10
Publication statusPublished - Oct 1 2013



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

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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