A case-control study of Clostridioides difficile symptomatic infections in a pediatric cancer hospital

The aim of this study was to analyze and identify documented infections and possible risk factors for Clostridioides difficile infections in children with cancer. This is a retrospective case-control study, carried out in a pediatric cancer hospital, covering the years 2016-2019. Matching was perfor...

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Published in:	Revista Paulista de Pediatria Vol. 41; p. e2022117
Main Authors:	Silva, Adriana Maria Paixão de Sousa da, Barbosa, Lara de Castro, Marques, Leticia Maria Acioli, Carreira, Letícia Yasuda, Fonseca, Fernanda Maria Casimiro da, Lima, Ana Paula Cordeiro, Sodré, Janaína Joice Martins, Pignati, Luara Teofilo, Araújo, Orlei Ribeiro, Silva, Dafne Cardoso Bourguignon da, Carlesse, Fabianne Altruda de Moraes Costa
Format:	Journal Article
Language:	English
Published:	Brazil Sociedade de Pediatria de São Paulo 01-01-2023
Subjects:	Anti-Bacterial Agents - therapeutic use Asparaginase - therapeutic use Busulfan - therapeutic use Cancer Cancer Care Facilities Carboplatin - therapeutic use Case-Control Studies Cefepime - therapeutic use Child Clostridioides difficile Clostridium Infections - chemically induced Clostridium Infections - drug therapy Clostridium Infections - epidemiology Cross Infection - chemically induced Cross Infection - drug therapy Cross Infection - epidemiology Humans Melphalan - therapeutic use Meropenem Neoplasms - complications Original Retrospective Studies Risk Factors Vancomycin
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Summary:	The aim of this study was to analyze and identify documented infections and possible risk factors for Clostridioides difficile infections in children with cancer. 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. 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). 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.
Bibliography:	Conflict of interests The authors declare there is no conflict of interests. Declaration The database that originated the article is available with the corresponding author.
ISSN:	0103-0582 1984-0462
DOI:	10.1590/1984-0462/2023/41/2022117