Clostridium Difficile infections in patients with AML or MDS undergoing allogeneic hematopoietic stem cell transplantation identify high risk for adverse outcome.
Journal
Bone marrow transplantation
ISSN: 1476-5365
Titre abrégé: Bone Marrow Transplant
Pays: England
ID NLM: 8702459
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
02
05
2019
accepted:
09
08
2019
revised:
11
07
2019
pubmed:
20
9
2019
medline:
22
6
2021
entrez:
20
9
2019
Statut:
ppublish
Résumé
Clostridium difficile (CD) infection is the main cause of nosocomial enterocolitis in western countries and in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHCT). Recipients of alloHCT are at high risk for CD infection but large studies in this population are rare and conflicting results have been reported. We analyzed 727 patients with AML or MDS undergoing alloHCT in our center from 2004 to 2015. Ninety-six patients (13%) had CD infection and 103 patients (14%) were identified as asymptomatic carriers by screening at admission and once a week during aplasia. Patients with CD infection had a shorter median overall survival of 8 months (95% CI, 6-36 months) compared with 25 months (95% CI, 17-35 months) for patients without CD infection, (HR 1.4, p = 0.04). CD positive patients were less likely to develop acute graft-versus-host disease (aGvHD; HR 0.6, p = 0.004) compared with CD-negative patients, but did not show differences in gastrointestinal aGvHD (HR 0.9, p = 0.5). Symptomatic patients developed gastrointestinal aGvHD (HR 2.5, p = 0.02) more often compared with asymptomatic CD positive patients. This analysis demonstrates a high prevalence for CD infection in patients undergoing alloHCT. A significant lower overall survival for patients with CD infection could be demonstrated.
Identifiants
pubmed: 31534193
doi: 10.1038/s41409-019-0678-y
pii: 10.1038/s41409-019-0678-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
367-375Références
Dubberke ER, Reske KA, Srivastava A, Sadhu J, Gatti R, Young RM, et al. Clostridium difficile-associated disease in allogeneic hematopoietic stem-cell transplant recipients: risk associations, protective associations, and outcomes. Clin Transplant. 2010;24:192–8.
doi: 10.1111/j.1399-0012.2009.01035.x
Dubberke ER, Sadhu J, Gatti R, Reske KA, DiPersio JF, Devine SM, et al. Severity of Clostridium difficile-associated disease (CDAD) in allogeneic stem cell transplant recipients: evaluation of a CDAD severity grading system. Infect Control Hosp Epidemiol. 2007;28:208–11.
doi: 10.1086/511792
Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. J Am Med Assoc. 2015;313:398–408.
doi: 10.1001/jama.2014.17103
Climo MW, Israel DS, Wong ES, Williams D, Coudron P, Markowitz SM. Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med. 1998;128:989–95.
doi: 10.7326/0003-4819-128-12_Part_1-199806150-00005
Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009;15:1143–238.
doi: 10.1016/j.bbmt.2009.06.019
Apostolopoulou E, Raftopoulos V, Terzis K, Elefsiniotis I. Infection Probability Score: a predictor of Clostridium difficile-associated disease onset in patients with haematological malignancy. Eur J Oncol Nurs. 2011;15:404–9.
doi: 10.1016/j.ejon.2010.11.002
Alonso CD, Kamboj M. Clostridium difficile infection (CDI) in solid organ and hematopoietic stem cell transplant recipients. Curr Infect Dis Rep. 2014;16:414.
doi: 10.1007/s11908-014-0414-0
Lo Vecchio A, Zacur GM. Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol. 2012;28:1–9.
doi: 10.1097/MOG.0b013e32834bc9a9
Longtin Y, Paquet-Bolduc B, Gilca R, Garenc C, Fortin E, Longtin J, et al. Effect of detecting and isolating Clostridium difficile carriers at hospital admission on the incidence of C difficile infections: a quasi-experimental controlled study. JAMA Intern Med. 2016;176:796–804.
doi: 10.1001/jamainternmed.2016.0177
Guddati AK, Kumar G, Ahmed S, Ali M, Kumar N, Hari P, et al. Incidence and outcomes of Clostridium difficile-associated disease in hematopoietic cell transplant recipients. Int J Hematol. 2014;99:758–65.
doi: 10.1007/s12185-014-1577-z
Lavallée C, Labbé AC, Talbot JD, Alonso CD, Marr KA, Cohen S, et al. Risk factors for the development of Clostridium difficile infection in adult allogeneic hematopoietic stem cell transplant recipients: A single-center study in Québec, Canada. Transpl Infect Dis. 2017;19:e12648. https://doi.org/10.1111/tid.12648 .
doi: 10.1111/tid.12648
Willems L, Porcher R, Lafaurie M, Casin I, Robin M, Xhaard A, et al. Clostridium difficile infection after allogeneic hematopoietic stem cell transplantation: incidence, risk factors, and outcome. Biol Blood Marrow Transplant. 2012;18:1295–301.
doi: 10.1016/j.bbmt.2012.02.010
Staffas A, Burgos da Silva M, van den Brink MR. The intestinal microbiota in allogeneic hematopoietic cell transplant and graft-versus-host disease. Blood. 2017;129:927–33.
Vehreschild MJ, Weitershagen D, Biehl LM, Tacke D, Waldschmidt D, Töx U, et al. Clostridium difficile infection in patients with acute myelogenous leukemia and in patients undergoing allogeneic stem cell transplantation: epidemiology and risk factor analysis. Biol Blood Marrow Transplant. 2014;20:823–8.
doi: 10.1016/j.bbmt.2014.02.022
Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation. 1974;18:295–304.
doi: 10.1097/00007890-197410000-00001
Armand P, Gibson CJ, Cutler C, Ho VT, Koreth J, Alyea EP, et al. A disease risk index for patients undergoing allogeneic stem cell transplantation. Blood. 2012;120:905–13.
doi: 10.1182/blood-2012-03-418202
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:E82–7.
doi: 10.1111/j.1399-0012.2010.01331.x
Bruminhent J, Wang ZX, Hu C, Wagner J, Sunday R, Bobik B, et al. Clostridium difficile colonization and disease in patients undergoing hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2014;20:1329–34.
doi: 10.1016/j.bbmt.2014.04.026
Jain T, Croswell C, Urday-Cornejo V, Awali R, Cutright J, Salimnia H, et al. Clostridium difficile colonization in hematopoietic stem cell transplant recipients: a prospective study of the epidemiology and outcomes involving toxigenic and nontoxigenic strains. Biol Blood Marrow Transplant. 2016;22:157–63.
doi: 10.1016/j.bbmt.2015.07.020
Kinnebrew MA, Lee YJ, Jenq RR, Lipuma L, Littmann ER, Gobourne A, et al. Early Clostridium difficile infection during allogeneic hematopoietic stem cell transplantation. PLoS ONE. 2014;9:e90158.
doi: 10.1371/journal.pone.0090158
Mehta RS, Rezvani K. Immune reconstitution post allogeneic transplant and the impact of immune recovery on the risk of infection. Virulence. 2016;7:901–16.
doi: 10.1080/21505594.2016.1208866
Bobak D, Arfons LM, Creger RJ, Lazarus HM. Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm? Bone Marrow Transplant. 2008;42:705–13.
doi: 10.1038/bmt.2008.317
Kamboj M, Xiao K, Kaltsas A, Huang YT, Sun J, Chung D, et al. Clostridium difficile infection after allogeneic hematopoietic stem cell transplant: strain diversity and outcomes associated with NAP1/027. Biol Blood Marrow Transplant. 2014;20:1626–33.
doi: 10.1016/j.bbmt.2014.06.025
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 Transplant. 2000;26:871–6.
doi: 10.1038/sj.bmt.1702627
Trifilio SM, Pi J, Mehta J. Changing epidemiology of Clostridium difficile-associated disease during stem cell transplantation. Biol Blood Marrow Transplant. 2013;19:405–9.
doi: 10.1016/j.bbmt.2012.10.030
Beelen DW, Elmaagacli A, Müller KD, Hirche H, Schaefer UW. Influence of intestinal bacterial decontamination using metronidazole and ciprofloxacin or ciprofloxacin alone on the development of acute graft-versus-host disease after marrow transplantation in patients with hematologic malignancies: final results and long-term follow-up of an open-label prospective randomized trial. Blood. 1999;93:3267–75.
doi: 10.1182/blood.V93.10.3267.410k22_3267_3275
Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versus-host disease. Lancet. 2009;373:1550–61.
doi: 10.1016/S0140-6736(09)60237-3
Feltis BA, Kim AS, Kinneberg KM, Lyerly DL, Wilkins TD, Erlandsen SL, et al. Clostridium difficile toxins may augment bacterial penetration of intestinal epithelium. Arch Surg. 1999;134:1235–41. discussion 41-2.
doi: 10.1001/archsurg.134.11.1235
Mathewson ND, Jenq R, Mathew AV, Koenigsknecht M, Hanash A, Toubai T, et al. Gut microbiome-derived metabolites modulate intestinal epithelial cell damage and mitigate graft-versus-host disease. Nat Immunol. 2016;17:505–13.
doi: 10.1038/ni.3400