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Evaluating Risk Factors for Clostridium difficile Infection In Stem Cell Transplant Recipients: A National Study

Published online by Cambridge University Press:  23 March 2017

Nishi N. Shah ,
William McClellan ,
Christopher R. Flowers ,
Sagar Lonial ,
Hannah Khoury ,
Edmund K. Waller ,
Amelia Langston  and
Ajay K. Nooka
Nishi N. Shah*
Affiliation:
University of Arkansas for Medical Sciences, Little Rock, Arkansas
William McClellan
Affiliation:
Rollins School of Public Health, Emory University, Atlanta, Georgia
Christopher R. Flowers
Affiliation:
Winship Cancer Institute, Emory University, Atlanta, Georgia
Sagar Lonial
Affiliation:
Winship Cancer Institute, Emory University, Atlanta, Georgia
Hannah Khoury
Affiliation:
Winship Cancer Institute, Emory University, Atlanta, Georgia
Edmund K. Waller
Affiliation:
Winship Cancer Institute, Emory University, Atlanta, Georgia
Amelia Langston
Affiliation:
Winship Cancer Institute, Emory University, Atlanta, Georgia
Ajay K. Nooka
Affiliation:
Winship Cancer Institute, Emory University, Atlanta, Georgia
*
Address correspondence to University of Arkansas for Medical Sciences, Little Rock, Arkansas; Corresponding address: 2200 Riverfront Dr, Apt 3208, Little Rock, AR 72202 (nnshah@uams.edu).
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Abstract

OBJECTIVE

Large-scale studies evaluating risk factors for Clostridium difficile infection (CDI), a leading cause of infectious diarrhea among patients undergoing stem cell transplantation (SCT), are lacking. We have evaluated risk factors for CDI among both autologous SCT (auto-SCT), and allogeneic SCT (allo-SCT) recipients using the National Inpatient Sample (NIS) database provided by the Healthcare Cost and Utilization Project (HCUP).

METHODS

We used patient data obtained from the NIS database for all adult patients admitted for auto- and allo-SCTs from January 2001 to December 2010. We performed multivariate logistic regression analyses to evaluate risk factors of CDI in auto- and allo-SCT patients.

RESULTS

Auto-SCTs constituted 61.5% of all SCTs performed during the study period. Of the 53,072 auto-SCT patients, 5.8% had CDI, whereas 8.5% of 33,189 allo-SCT patients had CDI. Univariate analyses identified age, gender, indication for SCT, radiation as part of the conditioning regimen, respiratory failure, septicemia, lengthy hospital stay, and multiple comorbidities as risk factors for CDI in both subsets. On multivariate analyses for auto-SCT, there was significant correlation between age and the indication for transplant (P=.003), but the indication for either auto- or allo-SCT was not associated with CDI on multivariate analyses. The following factors were found to be associated with CDI: septicemia (auto-SCT odds ratio [OR],=1.64; 95% confidence interval [CI], 1.35–2; and allo-SCT OR, 1.69; 95% CI, 1.36–2.1), male gender (auto-SCT OR, 1.29; 95% CI, 1.09–1.53; and allo-SCT OR, 1.36; 95% CI, 1.18–1.57), lengthy hospital stay (auto-SCT OR, 2.81; 95% CI, 2.29–3.45; and allo-SCT OR, 2.63; 95% CI, 2.15–3.22), and presence of multiple comorbidities (auto-SCT OR, 1.32; 95% CI, 1.11–1.57; and allo-SCT OR, 1.18; 95% CI, 1.0–1.4).

CONCLUSIONS

The prevalence of CDI was higher among patients undergoing allo-SCT. CDI was significantly associated with longer hospital stay, septicemia, and male gender for auto- and allo-SCT recipients. While this analysis did not permit us to directly ascribe the associations to be causative for CDI, it identifies the more vulnerable population for CDI and provides a rationale for the development of more effective approaches to preventing CDI.

Infect Control Hosp Epidemiol 2017;38:651–657

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 6 , June 2017 , pp. 651 - 657
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. New Engl J Med 1989;320:204–210.Google Scholar
2. Jawa, RS, Mercer, DW. Clostridium difficile-associated infection: a disease of varying severity. Am J Surg 2012;204:836–842.Google Scholar
3. Lucado, J, Gould, C, Elixhauser, A. Clostridium difficile infections (CDI) in hospital stays, 2009: statistical brief #124. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality; 2006.Google Scholar
4. Lessa, FC, Gould, CV, McDonald, LC. Current status of Clostridium difficile infection epidemiology. Clin Infect Dis 2012;55:S65–S70.CrossRefGoogle ScholarPubMed
5. Gursoy, S, Guven, K, Arikan, T, et al. Clostridium difficile infection frequency in patients with nosocomial infections or using antibiotics. Hepatogastroenterology 2007;54:1720–1724.Google ScholarPubMed
6. Vital signs: preventing Clostridium difficile infections. Morb Mort Wkly Rept 2012;61:157–162.Google Scholar
7. Hall, AJ, Curns, AT, McDonald, LC, Parashar, UD, Lopman, BA. The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999–2007. Clin Infect Dis 2012;55:216–223.CrossRefGoogle ScholarPubMed
8. McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile . New Engl J Med 2005;353:2433–2441.Google Scholar
9. Kamboj, M, Son, C, Cantu, S, et al. Hospital-onset Clostridium difficile infection rates in persons with cancer or hematopoietic stem cell transplant: a C3IC network report. Infect Control Hosp Epidemiol 2012;33:1162–1165.Google Scholar
10. Chakrabarti, S, Lees, A, Jones, SG, Milligan, DW. Clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality. Bone Marrow Transpl 2000;26:871–876.Google Scholar
11. Alonso, CD, Treadway, SB, Hanna, DB, et al. Epidemiology and outcomes of Clostridium difficile infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 2012;54:1053–1063.Google Scholar
12. Aronsson, B, Granstrom, M, Mollby, R, Nord, CE. Serum antibody response to Clostridium difficile toxins in patients with Clostridium difficile diarrhoea. Infection 1985;13:97–101.Google Scholar
13. Kyne, L, Warny, M, Qamar, A, Kelly, CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. New Engl J Med 2000;342:390–397.Google Scholar
14. Alonso, CD, Marr, KA. Clostridium difficile infection among hematopoietic stem cell transplant recipients: beyond colitis. Curr Opin Infect Dis 2013;26:326–331.Google Scholar
15. Morris, AM, Jobe, BA, Stoney, M, Sheppard, BC, Deveney, CW, Deveney, KE. Clostridium difficile colitis: an increasingly aggressive iatrogenic disease? Arch Surgery 2002;137:1096–1100.Google Scholar
16. Slimings, C, Riley, TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother 2014;69:881–891.Google Scholar
17. Trifilio, SM, Pi, J, Mehta, J. Changing epidemiology of Clostridium difficile-associated disease during stem cell transplantation. Biol Blood Marrow Transpl 2013;19:405–409.Google Scholar
18. Willems, L, Porcher, R, Lafaurie, M, et al. Clostridium difficile infection after allogeneic hematopoietic stem cell transplantation: incidence, risk factors, and outcome. Biol Blood Marrow Transpl 2012;18:1295–1301.Google Scholar
19. Paul, M, Yahav, D, Fraser, A, Leibovici, L. Empirical antibiotic monotherapy for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 2006;57:176–189.Google Scholar
20. Agency for Healthcare Research and Quality R, MD. HCUP Databases, 2001–2010. Healthcare Cost and Utilization Project (HCUP) website. www.hcup-us.ahrq.gov/databases.jsp. Updated 2016. Accessed January 5, 2017.Google Scholar
21. Elixhauser, A, Steiner, C, Harris, DR, Coffey, RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.Google Scholar
22. Elixhauser, A, Steiner, C, Palmer, L. Clinical classifications software (CCS) 2015 users’ guide. Healthcare Cost and Utilization Project website. https://www.hcup-us.ahrq.gov/toolssoftware/ccs/CCSUsersGuide.pdf. Published 2014. Accessed January 5, 2017.Google Scholar
23. Chopra, T, Chandrasekar, P, Salimnia, H, Heilbrun, LK, Smith, D, Alangaden, GJ. Recent epidemiology of Clostridium difficile infection during hematopoietic stem cell transplantation. Clin. Transplant 2011;25:E82–E87.CrossRefGoogle ScholarPubMed
24. Halabi, WJ, Nguyen, VQ, Carmichael, JC, Pigazzi, A, Stamos, MJ, Mills, S. Clostridium difficile colitis in the United States: a decade of trends, outcomes, risk factors for colectomy, and mortality after colectomy. J Am Coll Surg 2013;217:802–812.CrossRefGoogle ScholarPubMed
25. Hassan, SA, Rahman, RA, Huda, N, Wan Bebakar, WM, Lee, YY. Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards. J Roy Coll Phys Edinburgh 2013;43:103–107.Google Scholar
26. Micek, ST, Schramm, G, Morrow, L, et al. Clostridium difficile infection: a multicenter study of epidemiology and outcomes in mechanically ventilated patients. Crit Care Med 2013;41:1968–1975.Google Scholar
27. Surawicz, CM, Brandt, LJ, Binion, DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013;108:478–499.CrossRefGoogle ScholarPubMed
28. Scheurer, DB, Hicks, LS, Cook, EF, Schnipper, JL. Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort. Epidemiol Infect 2007;135:1010–1013.Google Scholar
29. Dubberke, ER, Reske, KA, McDonald, LC, Fraser, VJ. ICD-9 codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 2006;12:1576–1579.Google Scholar
30. Koll, BS, Ruiz, RE, Calfee, DP, et al. Prevention of hospital-onset Clostridium difficile infection in the New York metropolitan region using a collaborative intervention model. J Healthcare Qual 2014;36:35–45.CrossRefGoogle ScholarPubMed
31. Davis, BM, Yin, J, Blomberg, D, Fung, IC. Impact of a prevention bundle on Clostridium difficile infection rates in a hospital in the southeastern United States. Am J Infect Control 2016;44:1729–1731.Google Scholar
32. Kakihana, K, Fujioka, Y, Suda, W, et al. Fecal microbiota transplantation for patients with steroid-resistant/dependent acute graft-versus-host disease of the gut. Blood 2016;128:2083–2088.Google Scholar