Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Clin Infect Dis. 2021 May 18;72(10):e460-e465. doi: 10.1093/cid/ciaa1184.
Patients with cancer are particularly vulnerable to Clostridioides difficile infection (CDI). Guidelines recommend a two-step diagnostic algorithm to differentiate carriers from CDI; however, there are limited data for this approach while including other confounding risk factors for diarrhea such as radiation, cytotoxic chemotherapy, and adoptive cell based therapies.
We conducted a prospective, non-interventional, single center, cohort study of cancer patients with acute diarrhea and C. difficile, identified in stools by nucleic acid amplification tests (NAAT) and culture. Fecal toxin A/B was detected by enzyme immunoassay (EIA) and isolates were ribotyped using 16s rRNA fluorescent sequencing. Patients were followed for 90 days to compare outcomes according to malignancy type, infecting ribotype, and EIA status.
We followed 227 patients with a positive NAAT. Of these, 87% were hospitalized and 83% had an active malignancy. EIA was confirmed positive in 80/227 (35%) of patients. Those with EIA+ were older (60 ± 18 years vs 54 ± 19 years., P = .01), more likely to fail therapy [24/80 (30%) vs 26/147 (18%), P = .04] and experience recurrence [20/80 (25%) vs 21/147(14%), P < .05]. We found a low prevalence (22%) of ribotypes historically associated with poor outcomes (002, 018, 027, 56, F078-126, 244) but their presence were associated with treatment failure [17/50 (34%) vs 33/177 (19%), P = .02].
When compared to cancer patients with fecal NAAT+/EIA-, patients with NAAT+/EIA+ CDI are less likely to respond to therapy and more likely to experience recurrence, particularly when due to ribotypes associated with poor outcomes.
癌症患者特别容易感染艰难梭菌（CDI）。指南建议采用两步诊断算法来区分带菌者和 CDI；然而，在包括其他导致腹泻的混杂风险因素（如放疗、细胞毒性化疗和过继细胞治疗）时，针对这种方法的数据有限。
我们对 227 例急性腹泻和粪便核酸扩增试验（NAAT）和培养鉴定的艰难梭菌阳性的癌症患者进行了前瞻性、非干预性、单中心队列研究。采用酶联免疫吸附试验（EIA）检测粪便毒素 A/B，采用 16s rRNA 荧光测序对分离株进行核糖体分型。对患者进行 90 天随访，根据恶性肿瘤类型、感染核糖体类型和 EIA 状态比较结局。
我们随访了 227 例 NAAT 阳性患者。其中，87%住院，83%有活动性恶性肿瘤。80/227（35%）患者 EIA 阳性。EIA+患者年龄较大（60 ± 18 岁 vs 54 ± 19 岁，P =.01），更有可能治疗失败[24/80（30%）vs 26/147（18%），P =.04]和复发[20/80（25%）vs 21/147（14%），P <.05]。我们发现，历史上与不良结局相关的核糖体类型（002、018、027、56、F078-126、244）的患病率较低（22%），但它们的存在与治疗失败相关[17/50（34%）vs 33/177（19%），P =.02]。
与粪便 NAAT+/EIA-的癌症患者相比，NAAT+/EIA+ CDI 患者对治疗的反应更差，更有可能复发，尤其是由于与不良结局相关的核糖体类型时。
