Clostridium difficile Infection and Limitations of Markers for Severity in Patients with Hematologic Malignancy

OBJECTIVE. To describe characteristics of Clostridium difficile infection (CDI) and markers of severe CDI among patients with hematologic malignancies. DESIGN. Case-control study. SETTING. Tertiary care teaching hospital. PATIENTS AND METHODS. Inpatients with hematologic malignancies and CDI were age and time matched with 2 control inpatients without hematologic malignancies. Chart reviews were performed, and C. difficile isolates were strain typed. RESULTS. Case patients (n = 41) and control patients (n = 82) patients were different in respect to receipt of immunosuppressive agents within 2 months (92.7% vs 25.6%; P < .0001); neutropenia within 2 months (75.6% vs 3.7%; P < .0001) and mean (+/- standard deviation) white blood cell (WBC) count at diagnosis (4.9 +/- 14.1 vs 11.8 +/- 6.8 x 10(3) cells/mL; P = .0002); baseline mean creatinine level (0.89 +/- 0.1 vs 1.6 +/- 2.4 mg/dL; P = .003), mean creatinine level at diagnosis (0.83 +/- 0.4 vs 1.85 +/- 1.9 mg/dL; P = .004), and creatinine increases of 1.5 times over baseline (2.4% vs 15.1%; P = .02). Immunosuppressive agents and creatinine level remained significant in multivariable analysis (P = .03 for both variables). Severity correlated with mortality when measured by alternate severity criteria but not when measured by the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America criteria, which are based solely on WBC count and creatinine elevation. The prevalence of the epidemic BI/NAP1/027 strain was similar in both groups. CONCLUSIONS. Patients with hematologic malignancies had lower creatinine levels at the time of CDI diagnosis compared with control patients. WBC counts also tended to be lower in case patients. CDI severity criteria based on WBC count and creatinine level may not be applicable to patients with hematologic malignancies. Infect Control Hosp Epidemiol 2013; 34(2): 127-132