An international study of cancer patients with Clostridioides difficile infection (CDI) found recurrence rates were significant and severe CDI episodes were common, but newer treatments were underused, researchers reported yesterday in the International Journal of Infectious Diseases.
The study of CDI cases reported at three Australian hospitals and one Spanish hospital from 2020 through 2022 focused on cancer patients because they are particularly vulnerable to CDI, owing to prolonged hospitalizations and exposure to antibiotics. In addition, while newer treatments such as fidaxomicin, bezlotoxumab, and fecal microbiota transplantation (FMT) have shown promise for reducing CDI recurrence in clinical trials, and fidaxomicin is now recommended as a first-line treatment for CDI, cancer patients have been underrepresented in those studies.
A total of 547 episodes of CDI among cancer patients were documented over the study period, primarily in patients with lymphoma (19.2%), acute myeloid leukemia (16.6%), and colorectal cancer (7.9%). Of these patients, 57.4% had been hospitalized before developing CDI, and 66.5% had received antibiotics within the preceding 30 days. Fifty percent of the episodes were classified as either severe or severely complicated.
Significant recurrence rate
The most commonly prescribed CDI therapy was vancomycin (81.5%), followed by metronidazole (15%) and fidaxomicin (9.1%). The 90-day recurrence rate was 15.6% and overall 90-day mortality was 22.3%, but CDI-attributable mortality was 4.9%. Independent risk factors for CDI recurrence were female sex (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.13 to 4.52), age >75 years (OR, 2.69; 95% CI, 1.30 to 5.59), dialysis (OR, 5.15; 95% CI, 1.45 to 18.27), vomiting at presentation (OR, 0.06; 95% CI, 0.01 to 0.55), colonic wall thickening in the CT abdomen (OR, 2.42; 95% CI, 1.06 to 5.49), and vancomycin therapy (OR 4.60, 95% CI 1.34-15.84).
The authors say they hope their findings encourage higher uptake of fidaxomicin, bezlotoxumab, and FMT in cancer patients with CDI.
“Although recurrence rates among these patients are significant, the use of fidaxomicin and other preventive measures was rare,” they wrote. “Importantly, we identified factors that may guide the initiation of such strategies in cancer patients.”
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