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Post-Transplant Events

Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma

Bone Marrow Transplantation volume 37, pages 517–521 (2006)Cite this article

Abstract

Diarrhea is a major cause of morbidity and discomfort for patients undergoing high-dose chemotherapy and autologous peripheral blood stem cell transplantation (APBSCT). There are multiple causes of diarrhea in patients undergoing transplantation including antineoplastic chemotherapy, antimicrobials and infection, including Clostridium difficile as the most common pathogen involved. The purpose of this study was to determine the incidence of C. difficile-associated diarrhea (CDAD) 1 week before and 30 days after APBSCT, and to identify risk factors for the development of CDAD including diagnosis. Two hundred and forty-two patients underwent APBSCT for multiple myeloma and lymphoma between October 1996 and October 2001 in two teaching hospitals. Diarrhea was reported in 157 (64.9%) subjects. One hundred and thirty-five out of the 157 subjects were tested for the presence of C. difficile toxin A. These subjects constitute the study group. The incidence of CDAD was 15%. Two thirds of the patients who developed CDAD had multiple myeloma and one third had lymphoma; this difference did not attain statistical significance. The use of cephalosporins (P=0.03) and the use of intravenous vancomycin (P=0.02) were the only identified risk factors associated with the development of CDAD. Patients treated with paclitaxel as part of the mobilization regimen had a lower incidence of CDAD than patients who received hematopoietic growth factor only (P=0.01).

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References

  1. Avery R, Pohlman B, Adal K, Bolwell B, Goldman M, Kalaycio M et al. High prevalence of diarrhea but infrequency of documented Clostridium difficile in autologous peripheral blood progenitor cell transplant recipients. Bone Marrow Transplant 2000; 25: 67–69.

    Article  CAS  Google Scholar 

  2. Tomblyn M, Gordon L, Singhal S, Tallman M, Williams S, Winter J et al. Rarity of toxigenic Clostridium difficile infections after hematopoietic stem cell transplantation: implications for symptomatic management of diarrhea. Bone Marrow Transplant 2002; 30: 517–519.

    Article  CAS  Google Scholar 

  3. Yolken RH, Bishop CA, Townsend TR, Bolyard EA, Bartlett J, Santos GW et al. Infectious gastroenteritis in bone marrow transplant recipients. N Engl J Med 1982; 306: 1010–1012.

    Article  CAS  Google Scholar 

  4. Cox GJ, Matsui SM, Lo RS, Hinds M, Bowden RA, Hackman RC et al. Etiology and outcome of diarrhea after marrow transplantation: a prospective study. Gastroenterology 1994; 107: 1398–1407.

    Article  CAS  Google Scholar 

  5. Yuen KY, Woo PC, Liang RH, Chiu EK, Chen FF, Wong SS et al. Clinical significance of alimentary tract microbes in bone marrow transplant recipients. Diagn Microbiol Infect Dis 1998; 30: 75–81.

    Article  CAS  Google Scholar 

  6. Bilgrami S, Feingold JM, Dorsky D, Edwards RL, Bona RD, Khan AM et al. Incidence and outcome of Clostridium difficile infection following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1999; 23: 1039–1042.

    Article  CAS  Google Scholar 

  7. Restrepo A, Schneider DL, Restrepo MI, Litofsky ID, Devore PE, Walsh T et al. High incidence of Clostridium difficile in patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 2002; 8: 104 (abstr 152).

    Google Scholar 

  8. Marts BC, Longo WE, Vernava III AM, Kennedy DJ, Daniel GL, Jones I . Patterns and prognosis of Clostridium difficile colitis. Dis Colon Rectum 1994; 37: 837–845.

    Article  CAS  Google Scholar 

  9. Bartlett JG . Antibiotic-associated diarrhea. Clin Infect Dis 1992; 15: 573–581.

    Article  CAS  Google Scholar 

  10. Lyerly DM . Clostridium difficile testing. Clin Microbiol Newsletter 1995; 17: 17–22.

    Article  Google Scholar 

  11. Kelly CP, LaMont JT . Clostridium difficile infection. Annu Rev Med 1998; 49: 375–390.

    Article  CAS  Google Scholar 

  12. Brown E, Talbot GH, Axelrod P, Provencher M, Hoegg C . Risk factors for Clostridium difficile toxin-associated diarrhea. Infect Control Hosp Epidemiol 1990; 11: 283–290.

    Article  CAS  Google Scholar 

  13. Kyne L, Warny M, Qamar A, Kelly CP . Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med 2000; 342: 390–397.

    Article  CAS  Google Scholar 

  14. Kyne L, Warny M, Qamar A, Kelly CP . Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet 2001; 357: 189–193.

    Article  CAS  Google Scholar 

  15. Riley TV . Antibiotic-associated diarrhoea. A costly problem. Pharmacoeconomics 1996; 10: 1–3.

    Article  CAS  Google Scholar 

  16. Hecht JR, Olinger EJ . Clostridium difficile colitis secondary to intravenous vancomycin. Dig Dis Sci 1989; 34: 148–149.

    Article  CAS  Google Scholar 

  17. Oldfield Jr EC . Clostridium difficile-associated diarrhea: risk factors, diagnostic methods, and treatment. Rev Gastroenterol Disord 2004; 4: 186–195.

    PubMed  Google Scholar 

  18. Anand A, Glatt AE . Clostridium difficile infection associated with antineoplastic chemotherapy: a review. Clin Infect Dis 1993; 17: 109–113.

    Article  CAS  Google Scholar 

  19. Rowinsky EK, Donehower RC . Paclitaxel (Taxol). N Engl J Med 1995; 332: 1004–1014.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Divisions of Hematology and Infectious Disease, University of Texas Health Science Center, San Antonio, TX, USA

    J I Arango, A Restrepo, N S Callander, J L Ochoa-Bayona, M I Restrepo, P Bradshaw, J Patterson & C O Freytes

  2. Audie L Murphy Division, South Texas Veterans Health Care System, San Antonio, TX, USA

    D L Schneider, N S Callander, J L Ochoa-Bayona, M I Restrepo, J Patterson & C O Freytes

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  1. J I Arango
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  2. A Restrepo
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  3. D L Schneider
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  4. N S Callander
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  6. M I Restrepo
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  7. P Bradshaw
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  8. J Patterson
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  9. C O Freytes
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Correspondence to J I Arango.

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Arango, J., Restrepo, A., Schneider, D. et al. Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma. Bone Marrow Transplant 37, 517–521 (2006). https://doi.org/10.1038/sj.bmt.1705269

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