nach oben

Supportive Care in Cancer

Erschienen in:

01.11.2013 | Original Article

Excess risk of Clostridium difficile infection in ovarian cancer is related to exposure to broad-spectrum antibiotics

verfasst von: Josephine S. Kim, Kristy K. Ward, Nina R. Shah, Cheryl C. Saenz, Michael T. McHale, Steven C. Plaxe

Erschienen in: Supportive Care in Cancer | Ausgabe 11/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of the study was to determine if a diagnosis of ovarian cancer is independently associated with an increased risk of Clostridium difficile infection (CDI).

Methods

The University HealthSystem Consortium database was queried to perform a retrospective cohort study of women with and without ovarian cancer who were diagnosed with CDI. Inpatients undergoing total hysterectomy from 2008 to 2012 were studied. Ovarian cancer patients were compared to non-ovarian cancer patients to evaluate relative risk (RR) of CDI. Adjustment was made for known or suspected CDI risk factors to determine RR of CDI independent of these variables.

Results

In this study, 115,203 patients were included. CDI was reported in 0.80 % of ovarian cancer patients and in 0.31 % of non-ovarian cancer patients (RR = 2.50; 95 % confidence interval (CI) = 2.02 to 3.35). Stratification by age, presence of other comorbidities, or administration of antineoplastic drugs did not significantly modify the elevated risk associated with ovarian cancer. Significantly increased risk in ovarian cancer patients was no longer observed after controlling for broad-spectrum antibiotic administration (RR = 1.28, 95 % CI = 0.39 to 4.13). Compared to non-ovarian cancer patients, ovarian cancer patients were more frequently treated with broad-spectrum antibiotics, had a 39 % longer mean duration of therapy, and had 2.5-fold greater mean total exposure to broad-spectrum antibiotics.

Conclusions

After adjustment for antibiotic use, ovarian cancer patients are not at excess risk of CDI. Additional studies are needed to understand the patterns of broad-spectrum antibiotic prescription for ovarian cancer patients leading to increased exposure. If feasible, reduction of this exposure may decrease morbidity in this population.

Lipp MJ, Nero DC, Callahan MA (2012) Impact of hospital-acquired Clostridium difficile. J Gastroenterol Hepatol 27(11):1733–1737. doi:10.1111/j.1440-1746.2012.07242.x PubMedCrossRef

Kyne L, Sougioultzis S, McFarland LV, Kelly CP (2002) Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol 23(11):653–659. doi:10.1086/501989 PubMedCrossRef

Kelly CP, Pothoulakis C, LaMont JT (1994) Clostridium difficile colitis. N Engl J Med 330(4):257–262. doi:10.1056/nejm199401273300406 PubMedCrossRef

Ricciardi R, Rothenberger DA, Madoff RD, Baxter NN (2007) Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 142(7):624–631. doi:10.1001/archsurg.142.7.624 PubMedCrossRef

Zerey M, Paton BL, Lincourt AE, Gersin KS, Kercher KW, Heniford BT (2007) The burden of Clostridium difficile in surgical patients in the United States. Surg Infect (Larchmt) 8(6):557–566. doi:10.1089/sur.2006.062 CrossRef

Lo Vecchio A, Zacur GM (2012) Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol 28(1):1–9. doi:10.1097/MOG.0b013e32834bc9a9 PubMedCrossRef

McCollum DL, Rodriguez JM (2012) Detection, treatment, and prevention of Clostridium difficile infection. Clin Gastroenterol Hepatol 10(6):581–592. doi:10.1016/j.cgh.2012.03.008 PubMedCrossRef

Hensgens MP, Goorhuis A, Dekkers OM, Kuijper EJ (2012) Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. J Antimicrob Chemother 67(3):742–748. doi:10.1093/jac/dkr508 PubMedCrossRef

Owens RC Jr, Donskey CJ, Gaynes RP, Loo VG, Muto CA (2008) Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 46(Suppl 1):S19–31. doi:10.1086/521859 PubMedCrossRef

10.

Wistrom J, Norrby SR, Myhre EB, Eriksson S, Granstrom G, Lagergren L, Englund G, Nord CE, Svenungsson B (2001) Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother 47(1):43–50. doi:10.1093/jac/47.1.43 PubMedCrossRef

11.

Dubberke ER, Reske KA, Yan Y, Olsen MA, McDonald LC, Fraser VJ (2007) Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis 45(12):1543–1549. doi:10.1086/523582 PubMedCrossRef

12.

Emoto M, Kawarabayashi T, Hachisuga MD, Eguchi F, Shirakawa K (1996) Clostridium difficile colitis associated with cisplatin-based chemotherapy in ovarian cancer patients. Gynecol Oncol 61(3):369–372PubMedCrossRef

13.

Masciullo V, Mainenti S, Lorusso D, Margariti PA, Scambia G (2010) Lethal Clostridium difficile colitis associated with paclitaxel and carboplatin chemotherapy in ovarian carcinoma: case report and review of the literature. Obstet Gynecol Int 2010. doi:10.1155/2010/74978

14.

Southern WN, Rahmani R, Aroniadis O, Khorshidi I, Thanjan A, Ibrahim C, Brandt LJ (2010) Postoperative Clostridium difficile-associated diarrhea. Surgery 148(1):24–30. doi:10.1016/j.surg.2009.11.021 PubMedCrossRef

15.

Carignan A, Allard C, Pepin J, Cossette B, Nault V, Valiquette L (2008) Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain. Clin Infect Dis 46(12):1838–1843. doi:10.1086/588291 PubMedCrossRef

16.

Fowler S, Webber A, Cooper BS, Phimister A, Price K, Carter Y, Kibbler CC, Simpson AJ, Stone SP (2007) Successful use of feedback to improve antibiotic prescribing and reduce Clostridium difficile infection: a controlled interrupted time series. J Antimicrob Chemother 59(5):990–995. doi:10.1093/jac/dkm014 PubMedCrossRef

17.

Talpaert MJ, Gopal Rao G, Cooper BS, Wade P (2011) Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother 66(9):2168–2174. doi:10.1093/jac/dkr253 PubMedCrossRef

18.

Aldeyab MA, Kearney MP, Scott MG, Aldiab MA, Alahmadi YM, Darwish Elhajji FW, Magee FA, McElnay JC (2012) An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. J Antimicrob Chemother 67(12):2988–2996. doi:10.1093/jac/dks330 PubMedCrossRef

Titel: Excess risk of Clostridium difficile infection in ovarian cancer is related to exposure to broad-spectrum antibiotics
verfasst von: Josephine S. Kim
Kristy K. Ward
Nina R. Shah
Cheryl C. Saenz
Michael T. McHale
Steven C. Plaxe
Publikationsdatum: 01.11.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 11/2013
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-1888-2

Springer Medizin

Excess risk of Clostridium difficile infection in ovarian cancer is related to exposure to broad-spectrum antibiotics