Incidence of diarrhea by Clostridium difficile in hematologic patients and hematopoietic stem cell transplantation patients: risk factors for severe forms and death

• Published in: Revista do Instituto de Medicina Tropical de São Paulo Vol. 56; no. 4; pp. 325 - 331
• Main Authors: Spadão, Fernanda, Gerhardt, Juliana, Guimarães, Thais, Dulley, Frederico, Almeida Junior, João Nóbrega de, Batista, Marjorie Vieira, Shikanai-Yasuda, Maria Aparecida, Levin, Anna Sara, Costa, Silvia Figueiredo
• Format: Journal Article
• Language: English
• Published: Brazil Instituto de Medicina Tropical de Sao Paulo 01.07.2014; Instituto de Medicina Tropical; Universidade de São Paulo (USP)
• Subjects: Adolescent; Adult; Aged; Bone marrow transplant; Brazil - epidemiology; C. difficile; Child; Clostridium difficile; Diarrhea - mortality; Enterocolitis, Pseudomembranous - mortality; Female; Hematologic Diseases; Hematology; Hematopoietic Stem Cell Transplantation - mortality; Humans; Incidence; Male; Microbiology; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Factors; Severity of Illness Index; TROPICAL MEDICINE; Young Adult; Brazil; Hematology; C. difficile; Bone marrow transplant
• ISSN: 0036-4665; 1678-9946; 1678-9946; 0036-4665
• DOI: 10.1590/S0036-46652014000400010

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.