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In the Literature, Clinical Infectious Diseases, Volume 78, Issue 6, 15 June 2024, Pages i–iii, https://doi.org/10.1093/cid/ciae277
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CLOSTRIDIOIDES DIFFICILE DISEASE IN HEMATOPOIETIC STEM CELL TRANSPLANTATION
Ragozzino S, Mueller NJ, Neofytos D, et al. Epidemiology, outcomes and risk factors for recurrence of Clostridioides difficile infections following allogeneic hematopoietic stem cell transplantation: a longitudinal retrospective multicenter study. Bone Marrow Transplant 2023; 59:278–1. doi:10.1038/s41409-023-02157-3
Ragozzino and colleagues reviewed cases of Clostridioides difficile infection (CDI) in adult allogeneic hematopoietic stem cell transplant (HCT) recipients seen between 2009 and 2018 at 3 Swiss HCT centers. The majority were transplanted for treatment of acute myelocytic or acute lymphoblastic leukemia and two-thirds underwent myeloablative conditioning. CDI occurred in 131 of 1540 (8.5%) allogeneic HCT recipients during a median follow-up of 3.7 years (interquartile range [IQR], 1.0–5.5 years). The laboratory diagnosis of CDI was made using the recommended 2-step approach in only two-thirds (65.6%), most frequently by toxin detection in glutamate dehydrogenase antigen–positive samples.
The median patient age was 51 years and 60.3% were male. The median interval from transplantation to diagnosis of CDI was 61 days (IQR, 10–180 days). Of the 131 patients, 112 (85%) had received antibiotics for therapeutic purposes in the previous 3 months and 126 (96.2%) received antibiotic prophylaxis—mostly trimethoprim-sulfamethoxazole (only 5 received prophylactic fluoroquinolones)—and 110 (84.0%) received a proton pump inhibitor. Within the last month prior to CDI, 56 (42.7%) had received chemotherapy and/or other immunosuppressive therapy (n = 102 [77.9%]) and 29.8% were neutropenic at the time of CDI diagnosis. Graft-versus-host disease (GVHD) prophylaxis included cyclosporine A in most, followed in frequency by methotrexate, antithymocyte globulin, and, in 34%, mycophenolate mofetil (which commonly causes diarrhea). Another frequent problem associated with diarrhea was acute GVHD involving the gastrointestinal tract, which was present in one-third. Thirteen percent had previously had an episode of CDI.
