Rising incidence of clostridium difficile infection and associated clinical outcomes in hospitalized cancer patients: A national perspective.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19095-e19095
Author(s):  
Shivani Dalal ◽  
Krunalkumar Patel ◽  
Dhruvil Radadiya ◽  
Kirtenkumar Patel
Keyword(s):  
Clostridium Difficile ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Clostridium Difficile Infection ◽  
Statistical Significance ◽  
Private Insurance ◽  
Continuous Variables ◽  
National Inpatient Sample ◽  
Significance Level ◽  
Mortality Cost

e19095 Background: Cancer patients are more prone to Clostridium difficile infection (CDI). Several factors such as increased exposure to antibiotics (either in the form of prophylaxis or treatment), being on chemotherapy, and frequent exposure to healthcare settings are responsible for this. Rate of CDI in these patients ranges from 10-20%. Here, we performed a retrospective analysis using the national inpatient sample to study the trend and to see whether CDI leads to poor outcomes in these patients. Methods: We have used National Inpatient Sample database from the year 2009 to 2015 to identify hospitalized adult patients with cancer using ICD-9 CM codes. Similarly, We also identified patients with concurrent CDI amongst all cancer patients. Our primary aims were to study the trend of CDI and associated outcomes in from of mortality, cost of hospitalization and length of stay. Incidence of CDI per 10,000 discharges in those patients over the study period was assessed. Outcomes related to CDI in cancer patients were compared with those without CDI. Categorical and continuous variables were compared between matched cohorts using Chi-square and Student’s t-test, respectively. Statistical significance level was set at < 0.05. All analyses were performed with the use of SAS (version 9.4). Results: Total of 6,035,966 cancer patients was identified over the study period. Out of which, 57,167 (0.9%) had concurrent CDI. Age, sex and race were comparable in both the groups. Incidence of CDI increased from 89 cases to 101 cases per 10,000 cancer patients (p-trend: < 0.05). Inpatient mortality was significantly higher in cancer patients with CDI compared to without CDI(12.1% vs 4.7%, p < 0.0001). Cost of hospitalization was almost 3 times higher ($36,243 vs $12,910, p < 0.0001).Median length of stay was almost four-fold longer (16 days vs 4 days, p < 0.0001). Patients with Medicare and Medicaid had higher percentages of CDI cases while patients with private insurance had lower percentages. Conclusions: Incidence of CDI in cancer patients is on the rise. CDI lead to higher mortality, cost of hospitalization, and length of stay in cancer patients. Preventive strategies in form of judicious use of antibiotics and prompt identification with treatment may help with reducing mortality and associated healthcare burden.

Incidence of graft versus host disease in peri transplant hospitalization after clostridium difficile infection.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7542-7542
Author(s):  
Drew Carl Drennan Murray ◽  
Rohit Kumar ◽  
Shruti Bhandari ◽  
Mohamed M. Hegazi
Keyword(s):  
Bone Marrow ◽  
Clostridium Difficile ◽  
Length Of Stay ◽  
Cord Blood ◽  
Clostridium Difficile Infection ◽  
Graft Versus Host Disease ◽  
Private Insurance ◽  
Hospital Charges ◽  
Host Disease ◽  
Graft Versus Host

7542 Background: Hyperacute graft versus host disease (GVHD) after allogenic stem cell transplantation (SCT) has adverse outcomes with increased rates of chronic GVHD and relapse. GVHD risks include mismatched related or matched unrelated donors, myeloablative conditioning, heavy pretreatment, and donor-recipient sex mismatch. Clostridium difficile infection (CDI) is a leading cause of diarrhea in immunocompromised patients. Proposed microbiome effect on immunity and GVHD in allogenic SCT recipients prompts concern of microbiome modulation from CDI and antibiotics inciting GVDH. Methods: National Inpatient Sample database 2014 for hospitalizations with allogeneic SCT in patients ≥18yo. Characteristics (age, sex, race, insurance, graft source, hospital type, region, comorbidities) were compared for hospitalizations with and without CDI. Primary outcome was the difference in the incidence of GVHD during the transplant hospitalization between the 2 groups. Other outcomes were mortality, length of stay and hospital charges. Chi-square, t-test, and multivariate logistic regression utilized. Results: Of 6210 patients with allogenic SCT, 745 (12%) had CDI during the transplant hospitalization. In transplanted patients without CDI the average age was 55yo, 43.9% female, 69.5% Caucasian (C), 7.1% African American (AA), 8.6% Hispanic (H), 32.1% had Medicare/Medicaid, 61.8% private insurance, 5.7% uninsured, 44.7% had hypertension, 13.7% had diabetes, graft source was 84.3% PBSC (peripheral blood stem cells), 11.3% bone marrow, and 4.4% cord blood. CDI group the average age was 52.5yo, 45.3% female, 73% C, 4.7% AA, 8.1% H, 25.7% had Medicare/Medicaid, 66.2% private insurance, 8.1% uninsured, 41.9% had hypertension, 10.1% had diabetes, graft source was 83.8% PBSC, 10.8% bone marrow, and 5.4% cord blood. 25.7% of patients with CDI developed GVHD during that hospitalization while 14.2% of patients without CDI developed GVHD during the hospital stay (OR 2.1, p < 0.001 multivariate analysis). GVHD during the hospitalization had no difference in length of stay (p = 0.32), total cost of stay (p = 0.50) or same hospitalization mortality (p = 0.94). Conclusions: Allogeneic SCT patients with CDI develop GVHD on the same hospitalization at significantly higher rates than patients without CDI. This is true after controlling for age, sex, race, insurance, comorbidities, graft source, hospital location, and type of institution. Despite known associations of early evidence of GVHD on relapse, overall mortality was not different between the two groups.

scholarly journals Fecal calprotectin concentrations in cancer patients with Clostridium difficile infection

2018 ◽  
Vol 37 (12) ◽  
pp. 2341-2346 ◽  
Author(s):  
Taojun He ◽  
Samuel E. Kaplan ◽  
Luz A. Gomez ◽  
Xuedong Lu ◽  
Lakshmi V. Ramanathan ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Cancer Patients ◽  
Clostridium Difficile Infection ◽  
Fecal Calprotectin

scholarly journals The Analysis of Risk Factors and Clinical-Demographic Characteristics of Patients with Clostridium Dificille Infection as Well as The Outcome of Their Treatment

2016 ◽  
Vol 17 (2) ◽  
pp. 139-144
Author(s):  
Ivana Raković ◽  
Biljana Popovska Jovicic ◽  
Andriana Bukonjic ◽  
Sara Petrovic ◽  
Petar Canovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Antibiotic Use ◽  
Demographic Characteristics ◽  
Medical Documentation ◽  
Hospital Treatment ◽  
Continuous Variables ◽  
Bacterial Strains ◽  
H2 Blockers

Abstract Pseudomembranous colitis is a frequent nosocomial infection associated with significant morbidity and mortality. Clostridium difficile infection incidence most frequently increases due to unreasonable antibiotic use and the appearance of new hypervirulent bacterial strains, which leads to prolonged hospitalization and an increase in the total cost of hospital treatment.This is a retrospective design study conducted at Clinical Centre Kragujevac from January to December 2014. The patient data were obtained from the protocol of the Virological Laboratory and from medical documentation. All statistical analyses were performed using the computer program SPSS. The descriptive statistical data are expressed as percentage values. Continuous variables are expressed as the arithmetic mean with the standard deviation.Clostridium difficile infection occurred more frequently with elderly patients (123 patients were over 65 years old). Out of 154 patients on antibiotic treatment, 110 patients were treated with a combination of two or more antibiotics from different pharmacological groups. The most represented antibiotics were from the cephalosporin (71.4%) and quinolone (46.3%) groups. A total of 85.8% of the patients used proton pump inhibitors and H2 blockers.Our results describe the clinical and demographic characteristics of patients with diagnosed Clostridium difficile infection. The most prevalent characteristics (age, antibiotic therapy, PPI and H2 blocker use), which other researchers have also mentioned as risk factors, were present in our study as well.

The economic effectiveness of fidaxomicin over vancomycin in treating clostridium difficile infection in cancer patients: A systematic review.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e18923-e18923
Author(s):  
Omar Khaled Mahmoud Abughanimeh ◽  
Laith Al momani ◽  
Tyler Morgan ◽  
Mouhanna Abu Ghanimeh ◽  
Timothy J. Pluard
Keyword(s):  
Systematic Review ◽  
Clostridium Difficile ◽  
Cancer Patients ◽  
Clostridium Difficile Infection ◽  
Economic Effectiveness

Patterns and determinants of chemotherapy-associated Clostridium difficile infection among cancer patients in the United States: A population-based study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19111-e19111
Author(s):  
Pramit Nadpara
Keyword(s):  
Prostate Cancer ◽  
Multiple Myeloma ◽  
Clostridium Difficile ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Clostridium Difficile Infection ◽  
The United States ◽  
Chemotherapeutic Agents

e19111 Background: Elderly cancer patients comprise a population that is vulnerable for Clostridium difficile infection (CDI). In addition to the frequent hospitalizations, the administration of chemotherapeutic agents has been associated with the development of CDI. The objective of this study was to identify the patterns and determinants of chemotherapy-associated CDI (Chemo-CDI), in a nationwide sample of elderly patients. Methods: We used NCI’s Surveillance, Epidemiology, and End Results registry linked Medicare (SEER-Medicare) 2007-2012 files. We included patients’ aged ≥65 year, with diagnosis of lung/breast/ovarian/colorectal/prostate cancer, or lymphoma/multiple myeloma/leukemia during 2008-2011. We excluded those not receiving chemotherapy, with non-continuous Medicare enrollment, or HMO enrollment. Chemotherapy receipt was identified using appropriate ICD-9/HCPCS/CPT codes. Incidence of CDI following chemotherapy were determined by identifying any claim with primary/secondary diagnosis of CDI during the two-month follow-up period. Recurrent Chemo-CDI was identified by presence of any claim that was > 2 weeks and ≤8 weeks from the index CDI diagnosis date. Covariates including antibodies/proton pump inhibitors usage were captured and included in the analysis. Chi-square tests, and hierarchical generalized logistic models were conducted to identify determinants of Chemo-CDI. Results: We identified 41,470 elderly patients with lung/breast/ovarian/colorectal/prostate cancer, or lymphoma/multiple myeloma/leukemia diagnosis during the study years. While few (266) patients developed Chemo-CDI within one year of diagnosis, more than 50% (136) of those patients developed recurrent Chemo-CDI. Patient characteristics were not associated with risk of developing Chemo-CDI, however, significant differences were observed in antibiotics/proton pump inhibitors exposure across all cancer types (p < 0.001). Treatment for Chemo-CDI mostly comprised of Metronidazole and oral Vancomycin. Conclusions: While the incidence of Chemo-CDI is lower among patients receiving chemotherapy, the rate of recurrent Chemo-CDI was significantly higher. Strategies to prevent CDI recurrence in this population are therefore warranted. Future studies should also explore the association between increased disease burden and comorbidity, and the risk of developing Chemo-CDI.

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