Low prevalence of Clostridioides difficile infection in Reference Hospitals in Oncology
DOI:
https://doi.org/10.33448/rsd-v10i6.15612Keywords:
Clostridioides difficile infection; Cancer; Antibiotics; Chemotherapy; qRT-PCR.Abstract
The severity and incidence of Clostridioides difficile infection (CDI) have increased over the last decade. Cancer predisposes patients to CDI due to increased exposure to risk factors. The present study aimed to determine the prevalence, clinical response, outcomes, risk factors as supported in the literature in cancer patients with CDI. This was a prospective cross-sectional study conducted at two reference centres in oncology in Recife-PE, Brazil and involved individuals aged ≥18 years who presented with diarrhoea 48 hours after hospital admission, from November 2017 to August 2019. CDI was diagnosed using real-time polymerase chain reaction (qRT-PCR). A total of 156 patients were included in the study, and CDI was detected in 7.05% (11/156) of the patients. All isolates were screened, and the DNA was isolated and amplified by qRT-PCR for the detection of genes coding for toxins A and B (tcdA and tcdB), binary toxin (cdtA), and triose phosphate isomerase (tpi). Breast cancer and acute lymphoid leukemia were the most frequent cancers (27.3% [3/11] and 18.2% [2/11], respectively); 90.9% (10/11) of the cases used antibiotics, and the mortality rate was 63.6% (7/11 patients). Despite the use of the qRT-PCR technique, which is the most sensitive and specific method for diagnosing CDI, it was found that the prevalence of the disease was low (7.05%; 11/156). There were no cases of severe CDI, and most cases found were mild, which suggests the circulation of strains with low virulence that determine lower morbidity and mortality.
References
Abughanimeh, O., Qasrawi, A., Kaddourah, O., Momani, L. A. &, Ghanimeh, M. A. (2018). Clostridium difficile infection in oncology patients: epidemiology, pathophysiology, risk factors, diagnosis, and treatment. Hospital Practice, 46(5), 266-277. https://doi.org/10.1080/21548331.2018.1533673.
Balassiano, I. T., Santos-Filho, J., Oliveira, M. P. B., Ramos, M. C., Japiassu, A. M., Reis, A. M., Brazier, J. S., Ferreira, E. O., & Domingues, R. M. C. P. (2010). An outbreak case of Clostridium difficile-associated diarrhea among elderly inpatients of an intensive care unit of a tertiary hospital in Rio de Janeiro, Brazil. Diagnostic Microbiology and Infectious Diseases, 68(4), 449-55.
Britton, R. A., & Young, V. B. (2014). Role of the intestinal microbiota in resistance to colonization by Clostridium difficile. Gastroenterology, 146, 1547-53.
Brown, K. A., Khanafer, N., Daneman, N., & Fismana, D.N. (2013). Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrobial Agents and Chemotherapy, 57(5), 2326–32.
Chang, G. Y., Dembry, L. M., & Banach, D. B. (2016). Epidemiology of Clostridium difficile infection in hospitalized oncology patients. American Journal of Infection Control, 44(11), 1408-1410.
Chopra,. T, Alangaden, G. J., & Chandrasekar, P. (2010). Clostridium difficile infection in Cancer patients and Hematopoietic Stem Cell Transplant Recipients. Expert Review of Anti-infective Therapy, 8, 1113-1119.
Chul, P., Ki-Eun, H., & Hak-Ryul, K. (2016). Overview of Clostridium difficile Infection in Cancer Patients. Journal of Infectious Diseases & Diagnosis, 1, 109.
Costa, C. L., Carvalho, C. B. M., González, R. H., Gifoni, M. A. C., Ribeiro, R. A., Quesada-Gómez, C., & Brito, G. A. C. (2017). Molecular epidemiology of Clostridium difficile infection in a Brazilian cancer hospital. Anaerobe, 48, 232-36. https://doi.org/10.1016/j.anaerobe.2017.10.001.
Delgado, A., Reveles, I. A., Cabello, F. T., & Reveles, K. R. (2017). Poorer outcomes among cancer patients diagnosed with Clostridium difficile infections in United States community hospitals. BMC Infectious Diseases, 17, 448. https://doi.org/10.1186/s12879-017-2553-z.
Dial, S., Alrasadi, K., Manoukian, C., Huang, A., & Menzies, D. (2004). Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case–control studies. CMAJ, 171(1), 33–38.
Fang, W. J., Da-Zhi, J., Yun, L., Cai-Yun, F., Peng, Z., Jiong, Q., Bing-Ru, T., Xiao-Gang, C., Yu-Long, Z., Jing, D., Wei-Hua, Z., Xue-Ren, F., Fan-Long, L., Xiao-Zhou, M., & Shu-Sen, Z. (2014). Clostridium difficile carriage in hospitalized cancer patients: a prospective investigation in eastern China. BMC Infectious Diseases, 14:523. https://doi.org/10.1186/1471-2334-14-523.
Fuereder, T., Koni, D., Gleiss, A., Kund, M., Makristathis, A., Zielinski, C., & Steininger, C. (2016). Risk factors for Clostridium difficile infection in hemato-oncological patients: A case control study in 144 patients. Scientific Reports, 6, 31498.
Garzotto, A. R., García, A. M., Unceta, N. M., Lopez, M. M., Orellana-Miguel, M. A., Díaz-García, C. V., Cortijo-Cascajares, S., Cortes-Funes, H., & Agulló-Ortuño, M. T. (2015). Risk factors associated with Clostridium difficile infection in adult oncology patients. Support Care Cancer, 23, 1569–1577. https://doi.org/ 10.1007/s00520-014-2506-7.
Gorschlüter, M., Glasmacher, A., Hahn, C., Schakowski, F., Ziske, C., Molitor, E., Marklein, G., Sauerbruch, T., & Schmidt-Wolf, I. G. (2001). Clostridium difficile infection in patients with neutropenia. Clinical Infectious Diseases, 33, 786-791.
Hebbard, A. I., Slavin, M. A., Reed, C., Trubiano, J. A., The, B. W., Haeusler, G. M., Thursky, K. A, & Worth, L. J. (2016). The epidemiology of Clostridium difficile infection in patients with cancer. Expert Review of Anti-infective Therapy, 14, 1077-1085.
Khan, A., Raza, S., Batul, S. A., Khan, M., Aksoy, T., Baig, M. A., & Berger, B. J. (2012). The evolution of Clostridium difficile infection in cancer patients: epidemiology, pathophysiology, and guidelines for prevention and management. Recent Patents Antiinfective Drug Discovery, 7(2), 157-70.
Kilic, A., Alam, M. J., Tisdel, N. L., Shan, D. N., Yapar, M., Yapar, M., Lasco, T. M., & Garey, K. W. (2015). Multiplex Real-Time PCR Method for Simultaneous Identification and Toxigenic Type Characterization of Clostridium difficile From Stool Samples. Annals of laboratory medicine, 35:306-313.
Knetsch, C. W., Bakker, D., De Boer, R. F, Sanders, I., Hofs, S., Kooistra-Smid, A. M. D, Corver, J., Eastwood, K., Wilcox, M. H., & Kuijper, E. J. (2011). Comparison of Real-Time PCR Techniques to Cytotoxigenic Culture Methods for Diagnosing Clostridium difficile Infection. Journal of clinical microbiology, 49(1), 227–231.
Krishna, S. G., Zhao, W., Apewokin, S. K., Krishna, K., Chepyala, P., & Anaissie. E. J. (2013). Risk factors, preemptive therapy, and antiperistaltic agents for Clostridium difficile infection in cancer patients. Transplant Infectious Diseases, 15, 493-501.
Kyne, L., Sougioultzis, S., McFarland, L. V., & Kelly, C. P. (2002). Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infection Control & Hospital Epidemiology, 23, 653-9.
Leffler, D. A., & Lamont, J. T. (2009). Treatment of Clostridium difficile-associated disease. Gastroenterology, 136, 1899-912.
Lessa, F. C., Gould, C. V., & Mcdonald, L. C. (2012). Current status of Clostridium difficile infection epidemiology. Clinical infectious diseases, 55(2), 65-70.
Mcglone, S. M., Bailey, R. R., Zimmer, S. M., Popovich, M. J., Tian, Y., Ufberg, P., Muder, R. R., & Lee, B. Y. (2012). The economic burden of Clostridium difficile. Clinical Microbiology and Infection, 18(3), 282-289.
MS/INCA/Estimativa de Câncer no Brasil, 2020- disponível em https://www.inca.gov.br/numeros-de-cancer.
Novack, L., Kogan, S., Gimpelevich, L., Howell, M., Borer, A., Kelly, C. P., Leffler, D. A., & Novack, V. (2014). Acid suppression therapy does not predispose to Clostridium difficile infection: the case of the potential bias. PLoS One, 9(10), e110790.
Pépin, J., Valiquette, L., & Cossette, B. (2005). Mortality attributable to nosocomial Clostridium difficile-associated disease during na epidemic caused by a hypervirulent strain in Quebec. CMAJ, 173, 1037-42.
Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica. UFSM.
Pires, R. N., Monteiro, A. A., Carneiro, L. C., Baethgen, L. F., Tavares, R., Lincho, C. S., Park, S., Perlin, D., Rodrigues, F. E. M., & Pasqualotto, A. C. (2014). Clostridium difficile infection in Brazil: a neglected problem? American Journal of Infection Control, 42(4), 459-60.
Raza, S., Baig, M. A., Russell, H., Gourdet, Y., & Berger, B. J. (2010). Clostridium difficile infection following chemotherapy. Recent Patents Antiinfective Drug Discovery, 5(1), 1-9.
Rupnik, M., Wilcox, M. H., & Gerding, D. N. (2009). Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nature Reviews Microbiology, 7(7), 526-36.
Scappaticci, G. B., Perissinotti, A. J., Nagel, J. L., Bixby, D. L., & Marini, B. L. (2017). Risk factors and impact of Clostridium difficile recurrence on haematology patients. Journal of Antimicrobial Chemotherapy, 72(5), 1488-1495.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Catarina Tenório; Paulo Sérgio Ramos de Araújo; Ana Kelly Lins; Carlos Roberto Weber Sobrinho; Vera Magalhães
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
