Kamboj Mini, Xiao Kun, Kaltsas Anna, Huang Yao-Ting, Sun Janet, Chung Dick, Wu Saliangi, Sheahan Anna, Sepkowitz Kent, Jakubowski Ann A, Papanicolaou Genovefa
Services of Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Medical College of Cornell University, New York, New York.
Services of Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Biol Blood Marrow Transplant. 2014 Oct;20(10):1626-33. doi: 10.1016/j.bbmt.2014.06.025. Epub 2014 Jun 25.
Allogeneic hematopoietic stem cell transplantation (HSCT) recipients are at high risk for developing Clostridium difficile infection (CDI). We studied the incidence, risk factors, NAP1/027 prevalence, and clinical outcomes, including acute lower gastrointestinal graft-versus-host disease (GI GVHD), associated with early CDI in this population. A retrospective review was conducted of patients who underwent allogeneic HSCT at Memorial Sloan Kettering Cancer Center from January 1, 2005 to September 30, 2010. Early CDI was defined as infection occurring from day -10 to day +40 from stem cell infusion. Among 793 patients who received allogeneic HSCTs, early CDI occurred in 11.9%; 56% cases were between day -5 and day +5. Overall incidence was 25.2 cases/10,000 at-risk days. There was a high prevalence of NAP1/027 strains during peak incidence (61% in 2008). NAP1/027 was the most common strain in both adult and pediatric cases (24% and 23%, respectively). CDI was clinically mild, including those due to NAP1/027. Metronidazole was the primary treatment for 91 of 94 patients, 7 of 8 cases refractory to metronidazole had no response to vancomycin, and none was due to NAP1/027. Relapse of CDI was common (31%). The cumulative incidence of GI GVHD in patients with and without early CDI was 6.8% and 8%, respectively (P = .5). Most cases of CDI occurred during conditioning or immediately after transplant. Despite high prevalence of NAP1/027, we found only mild disease. Most patients were treated successfully with metronidazole, irrespective of NAP1/027 status. There was no significant association between early CDI and subsequent development of GI GVHD. This study demonstrates the high incidence of CDI early after allogeneic HSCT with wide diversity among infecting strains. Despite the high prevalence of NAP1/027, the disease is mild but relapses are common. No association was found between CDI and subsequent development of GI GVHD.
异基因造血干细胞移植（HSCT）受者发生艰难梭菌感染（CDI）的风险很高。我们研究了该人群中与早期CDI相关的发病率、危险因素、NAP1/027流行率及临床结局，包括急性下消化道移植物抗宿主病（GI GVHD）。对2005年1月1日至2010年9月30日在纪念斯隆凯特琳癌症中心接受异基因HSCT的患者进行了回顾性研究。早期CDI定义为干细胞输注后第-10天至第+40天发生的感染。在793例接受异基因HSCT的患者中，早期CDI的发生率为11.9%；56%的病例发生在第-5天至第+5天之间。总体发病率为每10,000个危险日25.2例。在发病高峰期，NAP1/027菌株的流行率很高（2008年为61%）。NAP1/027是成人和儿童病例中最常见的菌株（分别为24%和23%）。CDI临床症状较轻，包括由NAP1/027引起的感染。94例患者中有91例的主要治疗药物为甲硝唑，8例对甲硝唑耐药的患者中有7例对万古霉素无反应，且均非由NAP1/027引起。CDI复发很常见（31%）。有和没有早期CDI的患者中，GI GVHD的累积发生率分别为6.8%和8%（P = 0.5）。大多数CDI病例发生在预处理期间或移植后即刻。尽管NAPI/027流行率很高，但我们发现疾病症状较轻。大多数患者用甲硝唑治疗成功，无论其NAP1/027状态如何。早期CDI与随后发生的GI GVHD之间无显著关联。这项研究表明，异基因HSCT后早期CDI的发生率很高，感染菌株具有广泛的多样性。尽管NAP1/027流行率很高，但疾病症状较轻，但复发很常见。未发现CDI与随后发生的GI GVHD之间存在关联。
