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Clostridium difficile Infection and Limitations of Markers for Severity in Patients with Hematologic Malignancy

Published online by Cambridge University Press:  02 January 2015

Michael S. Wang ,
Charlesnika T. Evans ,
Tulio Rodriguez ,
Dale N. Gerding  and
Stuart Johnson
Michael S. Wang*
Affiliation:
Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Charlesnika T. Evans
Affiliation:
Hines VA Hospital, Hines, Illinois Northwestern University Feinberg School of Medicine, Center for Healthcare Studies, Chicago, Illinois
Tulio Rodriguez
Affiliation:
Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Dale N. Gerding
Affiliation:
Loyola University Chicago Stritch School of Medicine, Maywood, Illinois Hines VA Hospital, Hines, Illinois
Stuart Johnson
Affiliation:
Loyola University Chicago Stritch School of Medicine, Maywood, Illinois Hines VA Hospital, Hines, Illinois
*
Lakeland Regional Medical Center, 1234 Napier Avenue, St. Joseph, MI 49085 (mwang@lakelandregional.org)
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Abstract

Objective.

To describe characteristics of Clostridium difficile infection (CDI) and markers of severe CDI among patients with hematologic malignancies.

Design.

Case-control study.

Setting.

Tertiary care teaching hospital.

Patients and Methods.

Inpatients with hematologic malignancies and CDI were age and time matched with 2 control inpatients without hematologic malignancies. Chart reviews were performed, and C. difficile isolates were strain typed.

Results.

Case patients (n = 41) and control patients (n = 82) patients were different in respect to receipt of immunosuppressive agents within 2 months (92.7% vs 25.6%; P < .0001); neutropenia within 2 months (75.6% vs 3.7%; P < .0001) and mean (± standard deviation) white blood cell (WBC) count at diagnosis (4.9 ± 14.1 vs 11.8 ± 6.8 × 103 cells/mL; P = .0002); baseline mean creatinine level (0.89 ± 0.1 vs 1.6 ± 2.4 mg/dL; P = .003), mean creatinine level at diagnosis (0.83 ± 0.4 vs 1.85 ± 1.9 mg/dL; P = .004), and creatinine increases of 1.5 times over baseline (2.4% vs 15.1%; P = .02). Immunosuppressive agents and creatinine level remained significant in multivariable analysis (P = .03 for both variables). Severity correlated with mortality when measured by alternate severity criteria but not when measured by the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America criteria, which are based solely on WBC count and creatinine elevation. The prevalence of the epidemic BI/NAP1/027 strain was similar in both groups.

Conclusions.

Patients with hematologic malignancies had lower creatinine levels at the time of CDI diagnosis compared with control patients. WBC counts also tended to be lower in case patients. CDI severity criteria based on WBC count and creatinine level may not be applicable to patients with hematologic malignancies.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 2 , February 2013 , pp. 127 - 132
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

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