Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Infections Post Transplant

Clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality

Bone Marrow Transplantation volume 26, pages 871–876 (2000)Cite this article

Abstract

We retrospectively evaluated 75 allogeneic stem cell transplant recipients to ascertain the incidence, risk factors and outcome of infection with Clostridium difficile. Ten patients (13%) had Clostridium difficile infection at a median of 38 days (range day −6 to day +72) following the transplant. There was no difference in the duration or severity of diarrhoea in patients with Clostridium difficile infection compared to the uninfected patients and no relationship to the prior antibiotic or chemotherapy usage, age, gender, underlying disease, donor type, CMV serostatus, total body irradiation or time to engraftment. The incidence of viral infections was increased in patients infected with Clostridium difficile (7/10 vs 15/65, P = 0.005, odds ratio 7.7), but the strongest association was with gvhd >grade 2 (5/10 vs 6/65 uninfected patients, P = 0.004, odds ratio 9.8). Patients infected with Clostridium difficile also suffered a higher non-relapse mortality with 7/10 patients succumbing to either GVHD or infections, compared to 19/65 patients in the uninfected group (P = 0.02, odds ratio 5.6). Thus Clostridium difficile infections in our study had a strong association with GVHD and increased non-relapse mortality. It is possible that Clostridium difficile toxin might predispose to increased severity of GVHD leading to an adverse outcome. Bone Marrow Transplantation (2000) 26, 871–876.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Bartlett JG . Antibiotic-associated diarrhoea Clin Infect Dis 1992 15: 573–581

    Article  CAS  Google Scholar 

  2. Anand A, Glatt AE . Clostridium difficile infection associated with antineoplastic chemotherapy: a review Clin Infect Dis 1993 17: 109–113

    Article  CAS  Google Scholar 

  3. Yolken RH, Bishop CA, Timothy TR et al. Infectious gastroenteritis in bone marrow transplant recipients New Engl J Med 1982 306: 1010–1012

    Article  CAS  Google Scholar 

  4. Cox GJ, Matsui SM, Lo RS et al. Etiology and outcome of diarrhea after marrow transplantation: a prospective study Gastroenterology 1994 107: 1398–1407

    Article  CAS  Google Scholar 

  5. Blakey JL, Barnes GL, Bishop RF, Ekert H . Infectious diarrhea in children undergoing bone marrow transplantation Aust N Z J Med 1989 19: 31–36

    Article  CAS  Google Scholar 

  6. Bilgrami S, Feingold JM, Dorsky D et al. Incidence and outcome of Clostridium difficile infection following autologous peripheral blood stem cell transplantation Bone Marrow Transplant 1999 23: 1039–1042

    Article  CAS  Google Scholar 

  7. Avery R, Pohlman B, Adal K et al. High prevalence of diarrhoea but infrequency of documented Clostridium difficile in autologous peripheral blood progenitor cell transplant recipients Bone Marrow Transplant 2000 25: 67–69

    Article  CAS  Google Scholar 

  8. Beelen DW, Haralambie E, Brandt H et al. Evidence that sustained growth suppression of intestinal anaerobic bacteria reduces the risk of acute graft-versus-host disease after sibling marrow transplantation Blood 1992 80: 2668–2676

    CAS  PubMed  Google Scholar 

  9. Thomas ED, Storb R, Clift RA et al. Bone marrow transplantation New Engl J Med 1975 292: 895–902

    Article  CAS  Google Scholar 

  10. Barbut F, Meynard JL, Guiguet M et al. Clostridium difficile-associated diarrhea in HIV-infected patients: epidemiology and risk factors J Acquir Immune Defic Syndr Hum Retrovirol 1997 16: 176–181

    Article  CAS  Google Scholar 

  11. Kelly CP . Immune response to Clostridium difficile infection Eur J Gastroenterol Hepatol 1996 8: 1048–1053

    Article  CAS  Google Scholar 

  12. Beelen DW, Elmaagacli A, Muller KD et al. Influence of intestinal bacterial decontamination using metronidazole and ciprofloxacin or ciprofloxacin alone on the development of acute graft-versus-host disease after marrow transplantation in patients with hematologic malignancies: final results and long-term follow-up of an open-label prospective randomized trial Blood 1999 93: 3267–3275

    CAS  PubMed  Google Scholar 

  13. Hill GR, Krengler W, Ferrara JM . The role of cytokines in acute graft-versus-host disease Cytokines Cell Mol Ther 1997 3: 257–266

    CAS  PubMed  Google Scholar 

  14. Hill GR, Crawford JM, Cooke KR et al. Total body irradiation and acute graft-versus-host disease: the role of gastrointestinal damage and inflammatory cytokines Blood 1997 90: 3204–3213

    CAS  PubMed  Google Scholar 

  15. Piguet PF, Grau GE, Allet B et al. Tumour necrosis factor/cachectin is an effector of skin and gut lesions of the acute phase of graft-versus-host disease J Exp Med 1987 166: 1280–1289

    Article  CAS  Google Scholar 

  16. Van Bekkum DW, Knaan S . Role of bacterial flora in development of intestinal lesions from graft-versus-host disease J Natl Cancer Inst 1977 58: 787–790

    Article  CAS  Google Scholar 

  17. Mazuski JE, Panesar N, Tolman K, Longo WE . In vitro effects of Clostridium difficile toxins on hepatocytes J Surg Res 1998 79: 170–178

    Article  CAS  Google Scholar 

  18. Melo Filho AA, Souza MH, Lyerly DM et al. Role of tumour necrosis factor and nitric oxide in the cytotoxic effects ofClostridium difficile toxin A and toxin B on macrophages Toxicon 1997 35: 743–752

    Article  CAS  Google Scholar 

  19. Feltis BA, Kim AS, Kinneberg KM et al. Clostridium difficile toxins may augment bacterial penetration of intestinal epithelium Arch Surg 1999 134: 1235–1241

    Article  CAS  Google Scholar 

  20. Heinzelmann M, Mercer-Jones MA, Gardner SA et al. Bacterial cell wall products increase monocyte HLA-DR and ICAM-1 without affecting lymphocyte CD 18 expression Cell Immunol 1997 176: 127–134

    Article  CAS  Google Scholar 

  21. Cleary RK, Grossmann R, Fernandez FB et al. Metronidazole may inhibit intestinal colonization with Clostridium difficile Dis Colon Rectum 1998 41: 464–467

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK

    S Chakrabarti & DW Milligan

  2. Department of Public Health Laboratory, Birmingham Heartlands Hospital, Birmingham, UK

    A Lees & SG Jones

Authors
  1. S Chakrabarti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Lees
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. SG Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. DW Milligan
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chakrabarti, S., Lees, A., Jones, S. et al. Clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality. Bone Marrow Transplant 26, 871–876 (2000). https://doi.org/10.1038/sj.bmt.1702627

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1702627

Keywords

This article is cited by

Search

Advanced search

Quick links