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A Case-control Study of Clostridioides Difficile Symptomatic Infections in a Pediatric Cancer Hospital

Overview
Journal Rev Paul Pediatr
Specialty Pediatrics
Date 2023 Mar 15
PMID 36921180
Authors
Adriana Maria Paixao De Sousa da Silva
Lara de Castro Barbosa
Leticia Maria Acioli Marques
Leticia Yasuda Carreira
Fernanda Maria Casimiro da Fonseca
Ana Paula Cordeiro Lima
Janaina Joice Martins Sodre
Luara Teofilo Pignati
Orlei Ribeiro Araujo
Dafne Cardoso Bourguignon da Silva
Fabianne Altruda de Moraes Costa Carlesse
Affiliations
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Abstract

Objective: The aim of this study was to analyze and identify documented infections and possible risk factors for Clostridioides difficile infections in children with cancer.

Methods: This is a retrospective case-control study, carried out in a pediatric cancer hospital, covering the years 2016-2019. Matching was performed by age and underlying disease, and for each case, the number of controls varied from 1 to 3. Logistic regression models were used to assess risk factors.

Results: We analyzed 63 cases of documented infection by C. difficile and 125 controls. Diarrhea was present in all cases, accompanied by fever higher than 38°C in 52.4% of the patients. Mortality was similar among cases (n=4; 6.3%) and controls (n=6; 4.8%; p=0.7). In all, 71% of patients in the case group and 53% in the control group received broad-spectrum antibiotics prior to the infection. For previous use of vancomycin, the Odds Ratio for C. difficile infection was 5.4 (95% confidence interval [95%CI] 2.3-12.5); for meropenem, 4.41 (95%CI 2.1-9.2); and for cefepime, 2.6 (95%CI 1.3-5.1). For the antineoplastic agents, the Odds Ratio for carboplatin was 2.7 (95%CI 1.2-6.2), melphalan 9.04 (95%CI 1.9-42.3), busulfan 16.7 (95%CI 2.1-134.9), and asparaginase 8.97 (95%CI 1.9-42.9).

Conclusions: C. difficile symptomatic infection in children with cancer was associated with previous hospitalization and the use of common antibiotics in cancer patients, such as vancomycin, meropenem, and cefepime, in the last 3 months. Chemotherapy drugs, such as carboplatin, melphalan, busulfan, and asparaginase, were also risk factors.

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