Arslan Muhammad, Shabbir Muhammad Usman, Farooq Umer, Bilal Baryah, Abbas Salma, Chaudhry Nahel, Qasim Muhammad, Nizamuddin Summiya
Infectious Diseases, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.
Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.
Cureus. 2025 Jan 18;17(1):e77616. doi: 10.7759/cureus.77616. eCollection 2025 Jan.
Objective The objective of this study is to investigate the predisposing factors, disease course, potential complications, role of primary prophylaxis, and overall clinical outcomes of infection (CDI) in cancer patients. Methods The study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. We analyzed the medical records of cancer patients diagnosed with CDI from July 2015 to July 2024 and collected data about demographic characteristics, clinical presentation, predisposing factors, treatment, complications, and mortality rates. We used SPSS version 25 (IBM Corp., Armonk, NY) for data analysis. Results Out of 61 patients, 55.7% (n=34) were men, and most of the patients belonged to the age group of 41-65 years (49.1%; n=30). Of the patients, 34.4% (n=21) had underlying hematological malignancy, while the majority of patients (63.9%; n=39) had underlying solid organ malignancy. A total of 45.9% (n=28) of patients had mild severity, whereas 16.3% (n=10) and 6.55% (n=4) were at severe and fulminant stages of CDI, respectively. The creatinine levels of 80.3% (n=49) of patients were less than 1.5 mg/dL. We also observed the prior antimicrobial use, previous hospitalization within the last four weeks, recent chemotherapy, and use of proton pump inhibitors (PPIs)/H2 antagonists in the past four weeks as predisposing factors in 78.6% (n=48), 72.1% (n=44), 55.7% (n=34), and 75.4% (n=46) of patients, respectively. A greater proportion of patients (68.8%; n=42) had hospital/ICU stays of less than 15 days. Of the patients, 29.6% (n=18) had comorbid conditions such as diabetes mellitus (DM), chronic kidney disease (CKD), hypertension (HTN), ischemic heart disease (IHD), hepatitis, and atrial fibrillation. Oral vancomycin was administered as the primary treatment in 78.6% (n=48) of patients. We noted the resolution of symptoms in 91.8% (n=56) of patients, while 83.6% (n=51) of patients developed no complications. Additionally, the radiological findings of the patients were negative for toxic megacolon. Moreover, 4.91% (n=3) of patients had recurrent infections, whereas all-cause 30-day mortality was 13.1% (n=8). The mortality rate was higher in patients with solid organ tumors (17.9%; n=7) as compared to those having hematological malignancy (4.76%; n=1). Regression analysis showed that recent chemotherapy had an odds ratio (OR) of 11.550 (95% confidence interval {CI}: 1.332-100.9; p=0.998). Conclusion Cancer patients, especially those with solid tumors presenting with symptoms suggestive of CDI and prior chemotherapy exposure, need careful evaluation and preemptive treatment as CDI-related mortality is higher in cancer patients. Early diagnosis and treatment in this population can be lifesaving. Moreover, all cancer patients should receive CDI prophylaxis when indicated.
目的 本研究旨在调查癌症患者感染艰难梭菌（CDI）的诱发因素、病程、潜在并发症、一级预防的作用以及总体临床结局。方法 本研究在巴基斯坦拉合尔的沙卡特汗姆纪念癌症医院及研究中心开展。我们分析了2015年7月至2024年7月期间诊断为CDI的癌症患者的病历，并收集了有关人口统计学特征、临床表现、诱发因素、治疗、并发症和死亡率的数据。我们使用SPSS 25版（IBM公司，纽约州阿蒙克）进行数据分析。结果 在61例患者中，55.7%（n = 34）为男性，大多数患者年龄在41 - 65岁之间（49.1%；n = 30）。在这些患者中，34.4%（n = 21）患有潜在血液系统恶性肿瘤，而大多数患者（63.9%；n = 39）患有潜在实体器官恶性肿瘤。共有45.9%（n = 28）的患者病情为轻度，而分别有16.3%（n = 10）和6.55%（n = 4）的患者处于CDI的重度和暴发性阶段。80.3%（n = 49）的患者肌酐水平低于1.5mg/dL。我们还观察到，78.6%（n = 48）、72.1%（n = 44）、55.7%（n = 34）和75.4%（n = 46）的患者分别将既往抗菌药物使用、过去四周内曾住院、近期化疗以及过去四周内使用质子泵抑制剂（PPI）/H2拮抗剂作为诱发因素。更大比例的患者（68.8%；n = 42）住院/入住重症监护病房（ICU）的时间少于15天。在这些患者中，29.6%（n = 18）患有合并症，如糖尿病（DM）、慢性肾脏病（CKD）、高血压（HTN）、缺血性心脏病（IHD）、肝炎和心房颤动。78.6%（n = 48）的患者接受口服万古霉素作为主要治疗。我们注意到91.8%（n = 56）的患者症状得到缓解，而83.6%（n = 51）的患者未出现并发症。此外，患者的影像学检查结果显示无中毒性巨结肠。而且，4.91%（n = 3）的患者出现反复感染，全因30天死亡率为13.1%（n = 8）。实体器官肿瘤患者的死亡率（17.9%；n = 7）高于血液系统恶性肿瘤患者（4.76%；n = 1）。回归分析显示，近期化疗的比值比（OR）为11.550（95%置信区间{CI}：1.332 - 100.9；p = 0.998）。结论 癌症患者，尤其是那些出现提示CDI症状且有既往化疗史的实体瘤患者，由于CDI相关死亡率在癌症患者中较高，需要仔细评估和预防性治疗。在这一人群中早期诊断和治疗可挽救生命。此外，所有癌症患者在有指征时均应接受CDI预防。
