Clostridioides difficile infection and recurrence in cancer patients (CIRCA): A multicentre, international study
Objectives: We aimed to describe the characteristics of Clostridioides difficile infection (CDI) in cancer patients, analysing risk factors for 90-day recurrence and attributable mortality. Methods: Retrospective analysis on all CDI episodes from 2020 to 2022 in three Australian hospitals and one Sp...
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Elsevier
2025-04-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971225000098 |
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| author | Pedro Puerta-Alcalde Jessica O'Keefe Rachel Woolstencroft Shipraa Kaul Néstor López Katie Cronin Andrew Lim Nicole Garcia-Pouton Míriam Álvarez Lynette Chee Mateu Espasa Ignacio Grafia Maria Suárez-Lledó Olivia Smibert Carolina Garcia-Vidal Monica A. Slavin Michelle K. Yong Alex Soriano Leon J. Worth |
| author_facet | Pedro Puerta-Alcalde Jessica O'Keefe Rachel Woolstencroft Shipraa Kaul Néstor López Katie Cronin Andrew Lim Nicole Garcia-Pouton Míriam Álvarez Lynette Chee Mateu Espasa Ignacio Grafia Maria Suárez-Lledó Olivia Smibert Carolina Garcia-Vidal Monica A. Slavin Michelle K. Yong Alex Soriano Leon J. Worth |
| author_sort | Pedro Puerta-Alcalde |
| collection | DOAJ |
| description | Objectives: We aimed to describe the characteristics of Clostridioides difficile infection (CDI) in cancer patients, analysing risk factors for 90-day recurrence and attributable mortality. Methods: Retrospective analysis on all CDI episodes from 2020 to 2022 in three Australian hospitals and one Spanish hospital. Logistic regression analyses were performed. Results: A total of 547 CDI episodes in cancer patients were documented. Treatment predominantly involved vancomycin (81.5%), followed by metronidazole (15.0%) and fidaxomicin (9.1%). Combined antibiotics were used in 61 (11.2%) episodes. The 90-day recurrence rate was 15.6%. Independent risk factors for CDI recurrence were female sex (OR 2.26, 95% CI 1.13-4.52), age >75 years (OR 2.69, 95% CI 1.30-5.59), dialysis (OR 5.15, 95% CI 1.45-18.27), vomiting at presentation (OR 0.06, 95% CI 0.01-0.55), colonic wall thickening in the CT abdomen (OR 2.42, 95% CI 1.06-5.49) and vancomycin therapy (OR 4.60, 95% CI 1.34-15.84). Overall, 90-day mortality was 22.3%, but attributable mortality was 4.9%. Risk factors for mortality attributed to CDI were age >65 years (OR 15.91, 95% CI 2.64-95.80), previous cerebrovascular disease (OR 20.27, 95% CI 3.12-131.84), antibiotic therapy within the last 30 days (OR 0.17, 95% CI 0.05-0.54), high-output diarrhoea (OR 6.68, 95% CI 1.68-26.56), high CRP-levels (OR 11.60, 95% CI 1.90-70.81) and need for treatment change (OR 6.65, 95% CI 2.20-20.08). Conclusions: CDI recurrence rates among cancer patients remain significant. Nonetheless, fidaxomicin and other preventive strategies are seldom used. We identified several factors that could inform the implementation of these strategies in cancer patients. |
| format | Article |
| id | doaj-art-0bceb591eb4946d6b5930a8c74860867 |
| institution | Kabale University |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
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| series | International Journal of Infectious Diseases |
| spelling | doaj-art-0bceb591eb4946d6b5930a8c748608672025-02-08T04:59:57ZengElsevierInternational Journal of Infectious Diseases1201-97122025-04-01153107785Clostridioides difficile infection and recurrence in cancer patients (CIRCA): A multicentre, international studyPedro Puerta-Alcalde0Jessica O'Keefe1Rachel Woolstencroft2Shipraa Kaul3Néstor López4Katie Cronin5Andrew Lim6Nicole Garcia-Pouton7Míriam Álvarez8Lynette Chee9Mateu Espasa10Ignacio Grafia11Maria Suárez-Lledó12Olivia Smibert13Carolina Garcia-Vidal14Monica A. Slavin15Michelle K. Yong16Alex Soriano17Leon J. Worth18Department of Infectious Diseases, Hospital Clínic-IDIBAPS, Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Spain; Corresponding author: Pedro Puerta-Alcalde, Department of Infectious Diseases, Hospital Clínic-IDIBAPS, Barcelona, Spain, Carrer de Villarroel 170, 08036 Barcelona, Spain.Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, AustraliaDepartment of Infectious Diseases and National Center for Infection, Peter MacCallum Cancer Centre, Melbourne, VIC, AustraliaDepartment of Infectious Diseases and Microbiology, Austin Health, Melbourne, VIC, AustraliaDepartment of Infectious Diseases, Hospital Clínic-IDIBAPS, Barcelona, SpainMicrobiology Department, Royal Melbourne Hospital, Melbourne, VIC, AustraliaHaematology Department, Austin Health, Melbourne, VIC, AustraliaDepartment of Infectious Diseases, Hospital Clínic-IDIBAPS, Barcelona, SpainMicrobiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, SpainHaematology Department, Royal Melbourne Hospital, Melbourne, and Peter MacCallum Cancer Centre, Melbourne, VIC, AustraliaMicrobiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, SpainMedical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, SpainHaematology Department, Hospital Clínic, Barcelona, SpainDepartment of Infectious Diseases and Microbiology, Austin Health, Melbourne, VIC, AustraliaDepartment of Infectious Diseases, Hospital Clínic-IDIBAPS, Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Spain; CIBERINF, CIBER in Infectious Diseases, SpainVictorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Infectious Diseases and National Center for Infection, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, VIC, AustraliaVictorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Infectious Diseases and National Center for Infection, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, AustraliaDepartment of Infectious Diseases, Hospital Clínic-IDIBAPS, Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Spain; CIBERINF, CIBER in Infectious Diseases, SpainVictorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Infectious Diseases and National Center for Infection, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, VIC, AustraliaObjectives: We aimed to describe the characteristics of Clostridioides difficile infection (CDI) in cancer patients, analysing risk factors for 90-day recurrence and attributable mortality. Methods: Retrospective analysis on all CDI episodes from 2020 to 2022 in three Australian hospitals and one Spanish hospital. Logistic regression analyses were performed. Results: A total of 547 CDI episodes in cancer patients were documented. Treatment predominantly involved vancomycin (81.5%), followed by metronidazole (15.0%) and fidaxomicin (9.1%). Combined antibiotics were used in 61 (11.2%) episodes. The 90-day recurrence rate was 15.6%. Independent risk factors for CDI recurrence were female sex (OR 2.26, 95% CI 1.13-4.52), age >75 years (OR 2.69, 95% CI 1.30-5.59), dialysis (OR 5.15, 95% CI 1.45-18.27), vomiting at presentation (OR 0.06, 95% CI 0.01-0.55), colonic wall thickening in the CT abdomen (OR 2.42, 95% CI 1.06-5.49) and vancomycin therapy (OR 4.60, 95% CI 1.34-15.84). Overall, 90-day mortality was 22.3%, but attributable mortality was 4.9%. Risk factors for mortality attributed to CDI were age >65 years (OR 15.91, 95% CI 2.64-95.80), previous cerebrovascular disease (OR 20.27, 95% CI 3.12-131.84), antibiotic therapy within the last 30 days (OR 0.17, 95% CI 0.05-0.54), high-output diarrhoea (OR 6.68, 95% CI 1.68-26.56), high CRP-levels (OR 11.60, 95% CI 1.90-70.81) and need for treatment change (OR 6.65, 95% CI 2.20-20.08). Conclusions: CDI recurrence rates among cancer patients remain significant. Nonetheless, fidaxomicin and other preventive strategies are seldom used. We identified several factors that could inform the implementation of these strategies in cancer patients.http://www.sciencedirect.com/science/article/pii/S1201971225000098Clostridioides difficileClostridiumCancerColitisCDIRecurrence |
| spellingShingle | Pedro Puerta-Alcalde Jessica O'Keefe Rachel Woolstencroft Shipraa Kaul Néstor López Katie Cronin Andrew Lim Nicole Garcia-Pouton Míriam Álvarez Lynette Chee Mateu Espasa Ignacio Grafia Maria Suárez-Lledó Olivia Smibert Carolina Garcia-Vidal Monica A. Slavin Michelle K. Yong Alex Soriano Leon J. Worth Clostridioides difficile infection and recurrence in cancer patients (CIRCA): A multicentre, international study International Journal of Infectious Diseases Clostridioides difficile Clostridium Cancer Colitis CDI Recurrence |
| title | Clostridioides difficile infection and recurrence in cancer patients (CIRCA): A multicentre, international study |
| title_full | Clostridioides difficile infection and recurrence in cancer patients (CIRCA): A multicentre, international study |
| title_fullStr | Clostridioides difficile infection and recurrence in cancer patients (CIRCA): A multicentre, international study |
| title_full_unstemmed | Clostridioides difficile infection and recurrence in cancer patients (CIRCA): A multicentre, international study |
| title_short | Clostridioides difficile infection and recurrence in cancer patients (CIRCA): A multicentre, international study |
| title_sort | clostridioides difficile infection and recurrence in cancer patients circa a multicentre international study |
| topic | Clostridioides difficile Clostridium Cancer Colitis CDI Recurrence |
| url | http://www.sciencedirect.com/science/article/pii/S1201971225000098 |
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