Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma.

Department of Medicine, Division of Hematology, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA.
Bone Marrow Transplantation (Impact Factor: 3.47). 04/2006; 37(5):517-21. DOI: 10.1038/sj.bmt.1705269
Source: PubMed

ABSTRACT Diarrhea is a major cause of morbidity and discomfort for patients undergoing high-dose chemotherapy and autologous peripheral blood stem cell transplantation (APBSCT). There are multiple causes of diarrhea in patients undergoing transplantation including antineoplastic chemotherapy, antimicrobials and infection, including Clostridium difficile as the most common pathogen involved. The purpose of this study was to determine the incidence of C. difficile-associated diarrhea (CDAD) 1 week before and 30 days after APBSCT, and to identify risk factors for the development of CDAD including diagnosis. Two hundred and forty-two patients underwent APBSCT for multiple myeloma and lymphoma between October 1996 and October 2001 in two teaching hospitals. Diarrhea was reported in 157 (64.9%) subjects. One hundred and thirty-five out of the 157 subjects were tested for the presence of C. difficile toxin A. These subjects constitute the study group. The incidence of CDAD was 15%. Two thirds of the patients who developed CDAD had multiple myeloma and one third had lymphoma; this difference did not attain statistical significance. The use of cephalosporins (P = 0.03) and the use of intravenous vancomycin (P = 0.02) were the only identified risk factors associated with the development of CDAD. Patients treated with paclitaxel as part of the mobilization regimen had a lower incidence of CDAD than patients who received hematopoietic growth factor only (P = 0.01).

  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Clostridium difficile assoziierte Diarrhö (CDAD) wird häufig als lästige und relativ banale Nebenwirkung einer Antibiotikatherapie angesehen. Während schon in den 1980er und 90er Jahren Morbidität, Mortalität und entsprechend auch die Kosten von CDAD beträchtlich waren, sind diese aufgrund des Aufkommens eines hochvirulenten Stamms von Clostridium difficile (C. difficile) Anfang 2000 deutlich angestiegen. Die pathogenetischen Schlüsselereignisse sind Veränderungen der Darmflora nach Antibiotikagabe, Kolonisation mit einem toxinbildenden C. difficile und dessen intraluminale Vermehrung. Die Therapie besteht bei milden Formen im Absetzen der angeschuldigten Medikamente, bei mäßig bis schwer ausgeprägten Erkrankungen erfolgt die Gabe von Metronidazol oder Vancomycin per os. Als ultima ratio bei toxischem Megakolon muss die subtotale Hemikolektomie erwogen werden. Der verantwortungsvolle Einsatz von Antibiotika (,,antibiotic stewardship“) in Kombination mit spitalhygienischen Maßnahmen sind essenziell, um Ausbrüchen vorzubeugen und sie einzudämmen.
    Der Gastroenterologe 05/2007; 2(3).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients undergoing solid organ and stem cell transplantation are at increased risk of Clostridium difficile infection (CDI) compared with nontransplant patients. CDI may be associated with significant morbidity in this population including prolonged hospitalization, increased hospital charges, and complications in the transplanted organ. A combination of host factors, including both B-cell and T-cell immunosuppression, in addition to traditional risk factors for CDI such as broad-spectrum antibacterial exposure, are likely to contribute to the elevated risk in this population. This article addresses the current epidemiology and risk factors for CDI in transplant recipients, the downstream complications following this infection, and current management strategies, with an emphasis on novel approaches for primary and recurrent disease including fecal microbiota transplantation.
    Current Infectious Disease Reports 08/2014; 16(8):414.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematologic and patients undergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011, using two denominators 1,000 patient and 1,000 days of neutropenia and the risk factors associated with the severe form of the disease and death. The ELISA method (Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identify C. difficile. A multivariate analysis was performed to evaluate potential factors associated with severe CDAD and death within 14 days after the diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were identified in 64 patients among 439 patients with diarrhea during the study period. CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from 0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute myeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (45%) undergone allogeneic HSCT, 61/64 (88%) had previously used antibiotics and 9/64 (13%) have severe CDAD. Most of the patients (89%) received treatment with oral metronidazole and 19/64 (26%) died. The independent risk factors associated with death were the severe form of CDAD, and use of linezolid.
    Revista do Instituto de Medicina Tropical de São Paulo 07/2014; 56(4):325-31. · 0.96 Impact Factor


Available from

Similar Publications