Blood Res  
Determining the risk factors associated with the development of Clostridium difficile infection in patients with hematological disease
Yu Ling Lee-Tsai1, Rodrigo Luna-Santiago1, Roberta Demichelis-Gómez1, Alfredo Ponce-de-León2, Eric OchoaHein3, Karla María Tamez-Torres2, María T Bourlon1, Christianne Bourlon1
1Department of Hematology and Oncology, 2Department of Infectology, 3Departament of Hospital Epidemiology
and Quality Control of Medical Care, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México City, México
Correspondence to: Christianne Bourlon M.D.
1Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, C.P. 14080, México City, México
E-mail: chrisbourlon@hotmail.com
Published online: April 11, 2019.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background: Clostridium difficile infection (CDI) is a nosocomial condition prevalent in patients with hematological disorders. We aimed to identify the risk factors associated with the development of CDI and assess the mortality rate at 15 and 30 days among hematologic patients admitted to a tertiary care center.
Methods: We conducted a retrospective case-control study from January 2010 to December 2015. Forty-two patients with hematologic malignancy and CDI, and 84 with hematologic disease and without history of CDI were included in the case and control groups, respectively.
Results: Univariate analysis revealed that episodes of febrile neutropenia [odds ratio (OR), 5.5; 95% confidence interval (CI), 2.3–12.9; P<0.001], admission to intensive care unit (OR, 3.8; 95% CI, 1.4–10.2; P=0.009), gastrointestinal surgery (OR, 1.2; 95% CI, 1.1–1.4; P<0.001), use of therapeutic (OR, 6.4; 95% CI, 2.5–15.9; P<0.001) and prophylactic antibiotics (OR, 4.2; 95% CI, 1.6–10.7; P=0.003) in the last 3 months, and >1 hospitalization (OR, 5.6; 95% CI, 2.5–12.6; P<0.001) were significant risk factors. Multivariate analysis showed that use of therapeutic antibiotics in the last 3 months (OR, 6.3; 95% CI, 2.1–18.8; P=0.001) and >1 hospitalization (OR, 4.3; 95% CI, 1.7–11.0; P=0.002) were independent risk factors. Three (7.1%) and 6 (14.2%) case patients died at 15 and 30 days, respectively.
Conclusions: The risk factors for developing CDI were exposure to therapeutic antibiotics and previous hospitalization. Hematological patients who developed CDI had higher early mortality rates, suggesting that new approaches for prevention and treatment are needed.
Keywords: Clostridium difficile, Hematologic diseases, Risk factors, Tertiary care centers


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