Risk factors for the development of Clostridium difficile infection in adult allogeneic hematopoietic stem cell transplant recipients: A single-center study in Québec, Canada

Christian Lavallée, Annie Claude Labbé, Jean Daniel Talbot, Carolyn D. Alonso, Kieren Marr, Sandra Cohen, Michel Laverdière, Simon Frédéric Dufresne

Research output: Contribution to journalArticle

Abstract

Background: Clostridium difficile infection (CDI) is a significant complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our primary objective was to determine risk factors for the development of CDI during the first year following allo-HSCT. Methods: A matched case–control study nested in a cohort of allo-HSCT at a single hospital in Montréal, Québec, Canada, was conducted from 2002 through 2011. Results: Sixty-five of 760 patients who underwent allo-HSCT between 2002 and 2011 developed CDI, representing an incidence of 8.6%. We selected 123 controls matched for year of transplant for risk factor analyses. In the multivariable analysis, receipt of trimethoprim-sulfamethoxazole (TMP-SMX) prior to transplantation (adjusted odds ratio [aOR] 0.07, 95% confidence interval [CI] 0.02-0.27), mucositis (aOR 5.90, 95% CI 2.08-16.72), and reactivation of cytomegalovirus (CMV) (aOR 6.17, 95% CI 2.17-17.57) and of other Herpesviridae viruses (aOR 3.04, 95% CI 1.13-8.16) were the variables that remained statistically associated with CDI. High-risk antibiotic use in the late post-transplant period (aOR 7.63, 95% CI 2.14-27.22) was associated with development of late CDI. Conclusion: This study revealed reactivation of CMV and other Herpesviridae viruses as novel risk factors for CDI. Administration of TMP-SMX prior to transplantation was independently associated with a decreased risk of CDI. Early and late CDI after HSCT may have distinct risk factors.

Original languageEnglish (US)
Article numbere12648
JournalTransplant Infectious Disease
Volume19
Issue number1
DOIs
StatePublished - Feb 1 2017

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Clostridium Infections
Clostridium difficile
Hematopoietic Stem Cells
Canada
Transplants
Hematopoietic Stem Cell Transplantation
Odds Ratio
Confidence Intervals
Herpesviridae
Sulfamethoxazole Drug Combination Trimethoprim
Cytomegalovirus
Transplantation
Viruses
Mucositis
Transplant Recipients
Statistical Factor Analysis
Anti-Bacterial Agents
Incidence

Keywords

  • Clostridium difficile infection
  • cytomegalovirus
  • graft-versus-host disease
  • hematopoietic stem cell transplantation

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

Risk factors for the development of Clostridium difficile infection in adult allogeneic hematopoietic stem cell transplant recipients : A single-center study in Québec, Canada. / Lavallée, Christian; Labbé, Annie Claude; Talbot, Jean Daniel; Alonso, Carolyn D.; Marr, Kieren; Cohen, Sandra; Laverdière, Michel; Dufresne, Simon Frédéric.

In: Transplant Infectious Disease, Vol. 19, No. 1, e12648, 01.02.2017.

Research output: Contribution to journalArticle

Lavallée, Christian ; Labbé, Annie Claude ; Talbot, Jean Daniel ; Alonso, Carolyn D. ; Marr, Kieren ; Cohen, Sandra ; Laverdière, Michel ; Dufresne, Simon Frédéric. / Risk factors for the development of Clostridium difficile infection in adult allogeneic hematopoietic stem cell transplant recipients : A single-center study in Québec, Canada. In: Transplant Infectious Disease. 2017 ; Vol. 19, No. 1.
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abstract = "Background: Clostridium difficile infection (CDI) is a significant complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our primary objective was to determine risk factors for the development of CDI during the first year following allo-HSCT. Methods: A matched case–control study nested in a cohort of allo-HSCT at a single hospital in Montr{\'e}al, Qu{\'e}bec, Canada, was conducted from 2002 through 2011. Results: Sixty-five of 760 patients who underwent allo-HSCT between 2002 and 2011 developed CDI, representing an incidence of 8.6{\%}. We selected 123 controls matched for year of transplant for risk factor analyses. In the multivariable analysis, receipt of trimethoprim-sulfamethoxazole (TMP-SMX) prior to transplantation (adjusted odds ratio [aOR] 0.07, 95{\%} confidence interval [CI] 0.02-0.27), mucositis (aOR 5.90, 95{\%} CI 2.08-16.72), and reactivation of cytomegalovirus (CMV) (aOR 6.17, 95{\%} CI 2.17-17.57) and of other Herpesviridae viruses (aOR 3.04, 95{\%} CI 1.13-8.16) were the variables that remained statistically associated with CDI. High-risk antibiotic use in the late post-transplant period (aOR 7.63, 95{\%} CI 2.14-27.22) was associated with development of late CDI. Conclusion: This study revealed reactivation of CMV and other Herpesviridae viruses as novel risk factors for CDI. Administration of TMP-SMX prior to transplantation was independently associated with a decreased risk of CDI. Early and late CDI after HSCT may have distinct risk factors.",
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author = "Christian Lavall{\'e}e and Labb{\'e}, {Annie Claude} and Talbot, {Jean Daniel} and Alonso, {Carolyn D.} and Kieren Marr and Sandra Cohen and Michel Laverdi{\`e}re and Dufresne, {Simon Fr{\'e}d{\'e}ric}",
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T1 - Risk factors for the development of Clostridium difficile infection in adult allogeneic hematopoietic stem cell transplant recipients

T2 - A single-center study in Québec, Canada

AU - Lavallée, Christian

AU - Labbé, Annie Claude

AU - Talbot, Jean Daniel

AU - Alonso, Carolyn D.

AU - Marr, Kieren

AU - Cohen, Sandra

AU - Laverdière, Michel

AU - Dufresne, Simon Frédéric

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N2 - Background: Clostridium difficile infection (CDI) is a significant complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our primary objective was to determine risk factors for the development of CDI during the first year following allo-HSCT. Methods: A matched case–control study nested in a cohort of allo-HSCT at a single hospital in Montréal, Québec, Canada, was conducted from 2002 through 2011. Results: Sixty-five of 760 patients who underwent allo-HSCT between 2002 and 2011 developed CDI, representing an incidence of 8.6%. We selected 123 controls matched for year of transplant for risk factor analyses. In the multivariable analysis, receipt of trimethoprim-sulfamethoxazole (TMP-SMX) prior to transplantation (adjusted odds ratio [aOR] 0.07, 95% confidence interval [CI] 0.02-0.27), mucositis (aOR 5.90, 95% CI 2.08-16.72), and reactivation of cytomegalovirus (CMV) (aOR 6.17, 95% CI 2.17-17.57) and of other Herpesviridae viruses (aOR 3.04, 95% CI 1.13-8.16) were the variables that remained statistically associated with CDI. High-risk antibiotic use in the late post-transplant period (aOR 7.63, 95% CI 2.14-27.22) was associated with development of late CDI. Conclusion: This study revealed reactivation of CMV and other Herpesviridae viruses as novel risk factors for CDI. Administration of TMP-SMX prior to transplantation was independently associated with a decreased risk of CDI. Early and late CDI after HSCT may have distinct risk factors.

AB - Background: Clostridium difficile infection (CDI) is a significant complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our primary objective was to determine risk factors for the development of CDI during the first year following allo-HSCT. Methods: A matched case–control study nested in a cohort of allo-HSCT at a single hospital in Montréal, Québec, Canada, was conducted from 2002 through 2011. Results: Sixty-five of 760 patients who underwent allo-HSCT between 2002 and 2011 developed CDI, representing an incidence of 8.6%. We selected 123 controls matched for year of transplant for risk factor analyses. In the multivariable analysis, receipt of trimethoprim-sulfamethoxazole (TMP-SMX) prior to transplantation (adjusted odds ratio [aOR] 0.07, 95% confidence interval [CI] 0.02-0.27), mucositis (aOR 5.90, 95% CI 2.08-16.72), and reactivation of cytomegalovirus (CMV) (aOR 6.17, 95% CI 2.17-17.57) and of other Herpesviridae viruses (aOR 3.04, 95% CI 1.13-8.16) were the variables that remained statistically associated with CDI. High-risk antibiotic use in the late post-transplant period (aOR 7.63, 95% CI 2.14-27.22) was associated with development of late CDI. Conclusion: This study revealed reactivation of CMV and other Herpesviridae viruses as novel risk factors for CDI. Administration of TMP-SMX prior to transplantation was independently associated with a decreased risk of CDI. Early and late CDI after HSCT may have distinct risk factors.

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