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Risk factors and epidemiology of C lostridium difficile infection in hematopoietic stem cell transplant recipients during the peritransplant period
Author(s) -
Aldrete Sol del Mar,
Kraft Colleen S.,
Magee Matthew J.,
Chan Austin,
Hutcherson Don,
Langston Amelia A.,
Greenwell Brian I.,
Burd Eileen M.,
FriedmanMoraco Rachel
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12649
Subject(s) - medicine , clostridium difficile , hematopoietic stem cell transplantation , odds ratio , population , transplantation , confidence interval , surgery , antibiotics , environmental health , microbiology and biotechnology , biology
Abstract Background Hematopoietic stem cell transplant ( HSCT ) recipients represent a high‐risk group for developing C lostridium difficile ( CD ) infection ( CDI ). We aimed to identify specific risk factors for CDI in an HSCT patient population during the peritransplant period. Methods We performed a case–control study within a cohort of HSCT patients who received a transplant from November 2010 to March 2013. Cases had a clinical presentation compatible with CDI and a positive stool sample Xpert ® C . difficile test. Controls were CDI negative and matched on age, gender, and transplant type. Peritransplant period was defined as −30 days or time of stem cell mobilization maneuver to 30 days post transplant in autologous SCT or 90 days post transplant in allogeneic SCT . Results Of 781 HSCT s performed during the study period, 650 (83.2%) had a stool sample submitted for CD testing. Eight‐six (13.2%) cases with CDI were identified. Most of the cases were diagnosed within a week after transplantation (median of 5 days). In adjusted analysis, prior hospitalization (odds ratio [ OR ]: 2.01, 95% confidence interval [ CI ] 1.2‐3.36), prior cephalosporin administration ( OR 2.72, 95% CI : 1.54‐4.83), and prior chemotherapy ( OR : 3.26, 95% CI : 1.92‐5.5) were significantly associated with CDI . Conclusions Hospitalization, and prior antibiotic and chemotherapy use are risk factors that are not easily modifiable, which emphasizes the need to start investigating preventive or prophylactic strategies in this high‐risk population.