Impact of Clostridioides difficile Infections in Hospitalized Pediatric Oncology Patients

Clostridioides difficile infection (CDI) in pediatric oncology patients was found to have a  significant impact on length of hospital stay and affected adherence to scheduled chemotherapy plans, according to the findings of a retrospective cohort study published in the Journal of the Pediatric Infectious Diseases Society.

Study authors defined CDI as a positive laboratory result for detection of C difficile toxin in the liquid stool of a patient. Chemotherapy delay was assessed and the day of administration was determined. If therapy was delayed, the number of days by which treatment was delayed was identified.

The investigators examined 952 pediatric patients with 6567 admissions to St. Louis Children’s Hospital oncology service from July 2009 to February 2018. It was noted that for patients who experienced CDI, all admissions after the initial CDI episode were excluded, as prior CDI is a risk factor for subsequent CDI.

The study authors identified 109 (1.7%) CDI admissions from 109 (11.4%) unique patients, with the majority of infections classified as healthcare-associated. CDIs occurred in 54 of 109 patients with leukemia, 27 of 109 patients with solid tumors, and 29 of 109 patients who underwent hematopoietic stem cell transplantation.

CDI was significantly associated with leukemia and lymphoma diagnoses (odds ratio [OR], 3.0; 95% CI, 1.4-6.6) compared with solid tumor diagnoses (OR, 3.0; 95% CI, 1.3-6.8). Compared with patients who did not undergo transplantation, CDI was associated with autologous transplant (OR, 3.5; 95% CI, 1.7-7.4) but not with allogeneic transplant (OR, 1.4; 95% CI, 0.6-3.3). Antibiotic use was associated with CDI (OR, 3.0; 95% CI, 1.8-4.8). Acid suppression agents were not associated with CDI (OR, 0.5; 95% CI, 0.3-0.7). CDI exposure was strongly associated with CDI (OR, 84.7; 95% CI, 10.5-681.8).

CDI was strongly associated with increased length of stay compared with admissions without CDI, with a mean difference of 8 days (95% CI, 4.6-11.4). The prevalence of chemotherapy delay did not differ between admissions with or without CDI (OR, 1.6; 95% CI, 1.0-2.5); however, the average chemotherapy delay in admissions with CDI was 1.4 days (95% CI, 0.1-2.7) longer than in admissions without CDI.

“Larger, multi-institutional prospective trials are needed to further evaluate risk factors and to test interventions that may reduce infection rates. Additionally, coadmission with patients with CDI is highly associated with new cases of CDI. Improvements in and adherence to strict infection control practices will hopefully contribute to the reduction of infection rates and enhancement of patient care for this population,” the study authors concluded.

Reference

Willis DN, Huang FS, Elward AM, et al. Clostridioides difficile infections in inpatient pediatric oncology patients: a cohort study evaluating risk factors and associated outcomes. J Pediatric Infect Dis Soc. 2021;10(3):302-308. doi:10.1093/jpids/piaa090