Predictors of mortality attributable to Clostridium difficile infection in patients with underlying malignancy

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Abstract

Purpose: This study aimed at evaluating the clinical severity and treatment outcomes of Clostridium difficile infections (CDI) and identifying predictors associated with mortality in patients with malignancy. Methods: A retrospective study was conducted in a teaching hospital from January 2004 to June 2013. The subjects included adult patients (aged ≥18 years) receiving treatment for malignancy whose conditions were complicated by CDI. Clinical severity was determined using the guidelines from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA/IDSA). Multivariate logistic regression analysis was performed to identify predictors independently associated with CDI-related mortality. Results: Of the 5,594 patients treated for malignancy at the Division of Hematology/Oncology during the study period, 61 (1.1 %) had CDI complications. CDI-related mortality was 19.7 % (12/61). Twenty-seven (44.3 %) patients were diagnosed with neutropenia (ANC ≤500/mm3) at initial CDI presentation. Forty-one patients (67.2 %) received antimicrobial therapy for CDI. Based on the SHEA/IDSA guidelines, only 12 patients (19.7 %) presented with severe CDI, but 25 (61.0 %) patients experienced treatment failure. Multiple logistic regression modeling showed neutropenia to be an independent risk factor for CDI-related mortality (odds ratio, 5.17; 95 % confidence interval, 1.24-21.59). Conclusions: This study tracked poor CDI treatment outcomes in patients with malignancy and identified neutropenia as a previously unrecognized risk factor of CDI-related mortality. Alternative definitions of severe CDI that include neutropenia might be necessary to more accurately determine clinical severity.

Original languageEnglish
Pages (from-to)2039-2048
Number of pages10
JournalSupportive Care in Cancer
Volume22
Issue number8
DOIs
Publication statusPublished - 2014 Jan 1

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Clostridium Infections
Clostridium difficile
Mortality
Neoplasms
Neutropenia
Logistic Models
Guidelines
Hematology
Treatment Failure
Teaching Hospitals
Communicable Diseases
Epidemiology

ASJC Scopus subject areas

  • Oncology

Cite this

@article{c7d5c6da244b496fbb08ffbc6e96996f,
title = "Predictors of mortality attributable to Clostridium difficile infection in patients with underlying malignancy",
abstract = "Purpose: This study aimed at evaluating the clinical severity and treatment outcomes of Clostridium difficile infections (CDI) and identifying predictors associated with mortality in patients with malignancy. Methods: A retrospective study was conducted in a teaching hospital from January 2004 to June 2013. The subjects included adult patients (aged ≥18 years) receiving treatment for malignancy whose conditions were complicated by CDI. Clinical severity was determined using the guidelines from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA/IDSA). Multivariate logistic regression analysis was performed to identify predictors independently associated with CDI-related mortality. Results: Of the 5,594 patients treated for malignancy at the Division of Hematology/Oncology during the study period, 61 (1.1 {\%}) had CDI complications. CDI-related mortality was 19.7 {\%} (12/61). Twenty-seven (44.3 {\%}) patients were diagnosed with neutropenia (ANC ≤500/mm3) at initial CDI presentation. Forty-one patients (67.2 {\%}) received antimicrobial therapy for CDI. Based on the SHEA/IDSA guidelines, only 12 patients (19.7 {\%}) presented with severe CDI, but 25 (61.0 {\%}) patients experienced treatment failure. Multiple logistic regression modeling showed neutropenia to be an independent risk factor for CDI-related mortality (odds ratio, 5.17; 95 {\%} confidence interval, 1.24-21.59). Conclusions: This study tracked poor CDI treatment outcomes in patients with malignancy and identified neutropenia as a previously unrecognized risk factor of CDI-related mortality. Alternative definitions of severe CDI that include neutropenia might be necessary to more accurately determine clinical severity.",
keywords = "Clostridium difficile, Malignancy, Neutropenia, Treatment outcome",
author = "Yoon, {Young Kyung} and Min, {Ja Kim} and Sohn, {Jang Wook} and Kim, {Hye Suk} and Choi, {Yoon Ji} and Kim, {Jung Sun} and Kim, {Seung Tae} and Park, {Kyong Hwa} and Kim, {Seok Jin} and Kim, {Byung Soo} and Shin, {Sang Won} and Kim, {Yeul Hong} and Yong Park",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s00520-014-2174-7",
language = "English",
volume = "22",
pages = "2039--2048",
journal = "Supportive Care in Cancer",
issn = "0941-4355",
publisher = "Springer Verlag",
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TY - JOUR

T1 - Predictors of mortality attributable to Clostridium difficile infection in patients with underlying malignancy

AU - Yoon, Young Kyung

AU - Min, Ja Kim

AU - Sohn, Jang Wook

AU - Kim, Hye Suk

AU - Choi, Yoon Ji

AU - Kim, Jung Sun

AU - Kim, Seung Tae

AU - Park, Kyong Hwa

AU - Kim, Seok Jin

AU - Kim, Byung Soo

AU - Shin, Sang Won

AU - Kim, Yeul Hong

AU - Park, Yong

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose: This study aimed at evaluating the clinical severity and treatment outcomes of Clostridium difficile infections (CDI) and identifying predictors associated with mortality in patients with malignancy. Methods: A retrospective study was conducted in a teaching hospital from January 2004 to June 2013. The subjects included adult patients (aged ≥18 years) receiving treatment for malignancy whose conditions were complicated by CDI. Clinical severity was determined using the guidelines from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA/IDSA). Multivariate logistic regression analysis was performed to identify predictors independently associated with CDI-related mortality. Results: Of the 5,594 patients treated for malignancy at the Division of Hematology/Oncology during the study period, 61 (1.1 %) had CDI complications. CDI-related mortality was 19.7 % (12/61). Twenty-seven (44.3 %) patients were diagnosed with neutropenia (ANC ≤500/mm3) at initial CDI presentation. Forty-one patients (67.2 %) received antimicrobial therapy for CDI. Based on the SHEA/IDSA guidelines, only 12 patients (19.7 %) presented with severe CDI, but 25 (61.0 %) patients experienced treatment failure. Multiple logistic regression modeling showed neutropenia to be an independent risk factor for CDI-related mortality (odds ratio, 5.17; 95 % confidence interval, 1.24-21.59). Conclusions: This study tracked poor CDI treatment outcomes in patients with malignancy and identified neutropenia as a previously unrecognized risk factor of CDI-related mortality. Alternative definitions of severe CDI that include neutropenia might be necessary to more accurately determine clinical severity.

AB - Purpose: This study aimed at evaluating the clinical severity and treatment outcomes of Clostridium difficile infections (CDI) and identifying predictors associated with mortality in patients with malignancy. Methods: A retrospective study was conducted in a teaching hospital from January 2004 to June 2013. The subjects included adult patients (aged ≥18 years) receiving treatment for malignancy whose conditions were complicated by CDI. Clinical severity was determined using the guidelines from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA/IDSA). Multivariate logistic regression analysis was performed to identify predictors independently associated with CDI-related mortality. Results: Of the 5,594 patients treated for malignancy at the Division of Hematology/Oncology during the study period, 61 (1.1 %) had CDI complications. CDI-related mortality was 19.7 % (12/61). Twenty-seven (44.3 %) patients were diagnosed with neutropenia (ANC ≤500/mm3) at initial CDI presentation. Forty-one patients (67.2 %) received antimicrobial therapy for CDI. Based on the SHEA/IDSA guidelines, only 12 patients (19.7 %) presented with severe CDI, but 25 (61.0 %) patients experienced treatment failure. Multiple logistic regression modeling showed neutropenia to be an independent risk factor for CDI-related mortality (odds ratio, 5.17; 95 % confidence interval, 1.24-21.59). Conclusions: This study tracked poor CDI treatment outcomes in patients with malignancy and identified neutropenia as a previously unrecognized risk factor of CDI-related mortality. Alternative definitions of severe CDI that include neutropenia might be necessary to more accurately determine clinical severity.

KW - Clostridium difficile

KW - Malignancy

KW - Neutropenia

KW - Treatment outcome

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U2 - 10.1007/s00520-014-2174-7

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JO - Supportive Care in Cancer

JF - Supportive Care in Cancer

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