TY - JOUR
T1 - Clostridioides difficile Infection in Cancer and Immunocompromised Patients
T2 - Relevance of a Two-step Diagnostic Algorithm and Infecting Ribotypes on Clinical Outcomes
AU - Yepez Guevara, Eduardo A.
AU - Aitken, Samuel L.
AU - Olvera, Adilene V.
AU - Carlin, Lily
AU - Fernandes, Kerri E.
AU - Bhatti, Micah M.
AU - Garey, Kevin W.
AU - Adachi, Javier
AU - Okhuysen, Pablo C.
N1 - Funding Information:
Potential conflicts of interest. A. V. O. has received research funding from Merck Sharp and Dohme. P. C. O. has received research funding from Merck Sharp and Dohme, Summit Pharmaceuticals International, Deinove, and has served as a consultant for Jaguar health Inc. and Singulex Inc. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Funding Information:
Financial support. This work was supported by institutional funds at The University of Texas MD Anderson Cancer Center.
Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2021/5/15
Y1 - 2021/5/15
N2 - Background: Patients with cancer are particularly vulnerable to Clostridioides difficile infection (CDI). Guidelines recommend a two-step diagnostic algorithm to differentiate carriers from CDI; however, there are limited data for this approach while including other confounding risk factors for diarrhea such as radiation, cytotoxic chemotherapy, and adoptive cell based therapies. Methods: We conducted a prospective, non-interventional, single center, cohort study of cancer patients with acute diarrhea and C. difficile, identified in stools by nucleic acid amplification tests (NAAT) and culture. Fecal toxin A/B was detected by enzyme immunoassay (EIA) and isolates were ribotyped using 16s rRNA fluorescent sequencing. Patients were followed for 90 days to compare outcomes according to malignancy type, infecting ribotype, and EIA status. Results: We followed 227 patients with a positive NAAT. Of these, 87% were hospitalized and 83% had an active malignancy. EIA was confirmed positive in 80/227 (35%) of patients. Those with EIA+ were older (60 ± 18 years vs 54 ± 19 years., P =. 01), more likely to fail therapy [24/80 (30%) vs 26/147 (18%), P =. 04] and experience recurrence [20/80 (25%) vs 21/147(14%), P <. 05]. We found a low prevalence (22%) of ribotypes historically associated with poor outcomes (002, 018, 027, 56, F078-126, 244) but their presence were associated with treatment failure [17/50 (34%) vs 33/177 (19%), P =. 02]. Conclusions: When compared to cancer patients with fecal NAAT+/EIA-, patients with NAAT+/EIA+ CDI are less likely to respond to therapy and more likely to experience recurrence, particularly when due to ribotypes associated with poor outcomes.
AB - Background: Patients with cancer are particularly vulnerable to Clostridioides difficile infection (CDI). Guidelines recommend a two-step diagnostic algorithm to differentiate carriers from CDI; however, there are limited data for this approach while including other confounding risk factors for diarrhea such as radiation, cytotoxic chemotherapy, and adoptive cell based therapies. Methods: We conducted a prospective, non-interventional, single center, cohort study of cancer patients with acute diarrhea and C. difficile, identified in stools by nucleic acid amplification tests (NAAT) and culture. Fecal toxin A/B was detected by enzyme immunoassay (EIA) and isolates were ribotyped using 16s rRNA fluorescent sequencing. Patients were followed for 90 days to compare outcomes according to malignancy type, infecting ribotype, and EIA status. Results: We followed 227 patients with a positive NAAT. Of these, 87% were hospitalized and 83% had an active malignancy. EIA was confirmed positive in 80/227 (35%) of patients. Those with EIA+ were older (60 ± 18 years vs 54 ± 19 years., P =. 01), more likely to fail therapy [24/80 (30%) vs 26/147 (18%), P =. 04] and experience recurrence [20/80 (25%) vs 21/147(14%), P <. 05]. We found a low prevalence (22%) of ribotypes historically associated with poor outcomes (002, 018, 027, 56, F078-126, 244) but their presence were associated with treatment failure [17/50 (34%) vs 33/177 (19%), P =. 02]. Conclusions: When compared to cancer patients with fecal NAAT+/EIA-, patients with NAAT+/EIA+ CDI are less likely to respond to therapy and more likely to experience recurrence, particularly when due to ribotypes associated with poor outcomes.
KW - Cancer
KW - Clostridioides difficile
KW - Ribotype
KW - Toxin
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U2 - 10.1093/cid/ciaa1184
DO - 10.1093/cid/ciaa1184
M3 - Article
C2 - 32803229
AN - SCOPUS:85107082209
SN - 1058-4838
VL - 72
SP - E460-E465
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -