A Single-Center Experience and Literature Review of Management Strategies for Clostridium difficile Infection in Hematopoietic Stem Cell Transplant Patients

Introduction The aim of our study is to evaluate risk factors associated with the development of Clostridium difficile infection (CDI) in hematopoietic stem cell transplant (HSCT) patients, determine its incidence, and report outcomes of CDI in our patient population. Methods We performed a retrospective review of medical records of adult HSCT recipients diagnosed between 2013 and 2016 at our center. Logistic regression models were used to determine the relationship between risk factors and the odds of CDI. Results The overall incidence of CDI in HSCT patients was 9.4%. The incidence of CDI was higher in allogeneic HSCT (20%) versus autologous HSCT (4.8%). No statistically significant differences in age, sex, cancer type, and transplant type were found between those who developed CDI and those who did not. However, patients with CDI had a longer length of stay (25 days) and used more antibiotics (30 days prior to and during admission for HSCT) than non-CDI patients (19 days). Only 2 of 17 patients (11.8%) with CDI experienced recurrence among 180 patients after HSCT. No patient suffered from toxic megacolon or ileus, and no patient underwent colectomy. There was no mortality associated with CDI at our center. Conclusions Clostridium difficile infection has an incidence rate of 9.4% in HSCT recipients. Established risk factors including age, sex, cancer type, and transplant type were not identified as risk factors in our population. However, longer LOS and use of more than 4 lines of antibiotics were observed among those with CDI compared with those without CDI.