Incidence and risk factors for Clostridium difficile infection in patients with diarrhea during autologous hematopoietic stem cell transplantation

Abstract

Objective To investigate the incidence and risk factors for Clostridium difficile infection (CDI) in patients with diarrhea during autologous hematopoietic stem cell transplantation (auto-HSCT) and provide guidance for clinical diagnosis and treatment. Methods Clinical data of patients with diarrhea during auto-HSCT between May 2005 and July 2019 were collected and retrospectively analyzed. The patients with positive results of Clostridium difficile anaerobic culture and Clostridium difficile toxin A/B test were assigned into the CDI group, and the others were into the non-CDI group. The incidence and risk factors for CDI were analyzed in this case-control study. Results A total of 202 patients developed diarrhea during auto-HSCT in this study. Thirty-three patients suffered from CDI, with an incidence rate of 16.3% and a median onset of 12(8~17) d since the admission of transplantation ward. The results of the univariate analysis indicated that the incidence of CDI was associated with the administration of busulfan, bortezomib and carmustine (all P < 0.05). The multivariate analysis showed that busulfan and bortezomib were the independent risk factors for CDI (all P < 0.05). The median time of diarrhea was 6(4~9) d in CDI patients, and 2 patients (6.0%) developed septic shock and died. Conclusion The incidence rate of CDI is quite high in the patients with diarrhea during auto-HSCT. The administration of busulfan and bortezomib are risk factors for CDI.

Keywords

• autologous hematopoietic stem cell transplantation
• clostridium difficile infection
• incidence
• risk factor