Treating Clostridium difficile infection in patients presenting with hematological malignancies: Are current guidelines applicable?

• Published in: Médecine et maladies infectieuses 2017-12, Vol.47 (8), p.532-539
• Main Authors: Robin, C., Héquette-Ruz, R., Guery, B., Boyle, E., Herbaux, C., Galperine, T.
• Format: Article
• Language: English
• Subjects: Adult; Adults; Bacteria; Bacterial infections; Blood diseases; Clinical guidelines; Clinical outcomes; Clostridium difficile; Clostridium difficile - drug effects; Clostridium difficile infection; Clostridium Infections - drug therapy; Clostridium Infections - epidemiology; Compliance; Cross Infection - drug therapy; Cross Infection - microbiology; Diagnosis; Diagnostic systems; Disease Management; Female; Guidelines; Health risks; Hematologic Neoplasms - complications; Hematology; Hospital Units; Hospitals, Teaching; Humans; Hématologie; Immunocompromised Host; Infection à Clostridium difficile; Infections; Male; Medical treatment; Medication Adherence; Metronidazole - therapeutic use; Middle Aged; Mortality; Patients; Practice Guidelines as Topic; Recommandations; Recurrence; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Vancomycin - therapeutic use
• ISSN: 0399-077X; 1769-6690
• DOI: 10.1016/j.medmal.2017.07.002

Adults with hematological malignancies are at high-risk of Clostridium difficile infection (CDI), but no guidelines for CDI treatment are available in this population. Our primary objective was to evaluate the clinical outcomes in CDI patients with hematological malignancies. Our secondary objectives were to describe CDI severity using the main clinical guidelines and to evaluate the compliance of treatment choice with published guidelines. Single-center, retrospective, observational case series including every consecutive adult patient with a confirmed diagnosis of CDI admitted in the hematology unit of our teaching hospital. Each CDI episode was classified as moderate, severe, or complicated according to the main clinical guidelines (IDSA 2010, AJG 2013, ESCMID 2014). Twenty-three episodes of CDI in 19 patients admitted to the hematology unit occurred between June 2012 and October 2013. Clinical cure was achieved for 20 episodes (87%). Ten weeks after diagnosis, global cure was reached for 14 episodes (61%) whereas recurrence occurred in two episodes (10%). The mortality rate reached 37% (7/19) but the attributable mortality rate was 5% (1/19). ESCMID criteria more frequently classified patients in the severe category compared with the two other classifications. Prescription compliance with clinical guidelines was observed in 61% of episodes with IDSA criteria, 43% with AJG, and 9% with ESCMID. IDSA and AJG assessment may underestimate the potential risk of unfavorable clinical outcome. Further prospective studies on a larger cohort are needed to develop adequate treatment guidelines for CDI in hematology settings. Les patients d’hématologie sont à haut risque d’infection à Clostridium difficile (ICD). Il n’existe pas de recommandations spécifiques pour cette population. L’objectif principal était de décrire les épisodes d’ICD chez les patients avec hémopathie maligne et les objectifs secondaires d’évaluer leur gravité et l’adéquation du choix thérapeutique d’après les différentes recommandations publiées. Nous avons repris rétrospectivement tous les cas consécutifs de patients ayant un diagnostic d’ICD dans le département d’hématologie de notre hôpital universitaire. Chaque épisode d’ICD a été classé en modéré, grave ou compliqué selon les différentes recommandations (IDSA 2010, AJG 2013, ESCMID 2014). Vingt-trois épisodes d’ICD chez 19 patients ont été diagnostiqués entre juin 2012 et octobre 2013. La rémission complète a été obtenue pour 20 épisodes (