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An international study cancer patients Clostridioides difficile (CDI) found that recurrence rates were significant and serious episodes of CDI were common, but new treatments were underutilized, researchers reported yesterday in the International Journal of Infectious Diseases.

The study of CDI cases reported from three Australian hospitals and one Spanish hospital from 2020 to 2022 focused on cancer patients, as they are particularly vulnerable to CDI, due to prolonged hospitalizations and exposure to antibiotics. Furthermore, while new treatments such as fidaxomicin, bezlotoxumab, and fecal microbiota transplantation (FMT) have shown promise in reducing CDI recurrence in clinical trials, and fidaxomicin is now recommended as first-line therapy. Intended for ICDs, cancer patients have been underrepresented in these studies.

A total of 547 CDI episodes in patients with cancer were documented during the study period, primarily in patients with lymphoma (19.2%), acute myeloid leukemia (16.6%). and colorectal cancer (7.9%). Of these patients, 57.4% had been hospitalized before developing CDI and 66.5% had received antibiotics in the previous 30 days. Fifty percent of episodes were classified as severe or severely complicated.

High rate of recidivism

The most commonly prescribed ICD treatment was vancomycin (81.5%), followed by metronidazole (15%) and fidaxomicin (9.1%). The 90-day recurrence rate was 15.6% and the overall 90-day mortality was 22.3%, but the mortality attributable to CDI was 4.9%. Independent risk factors for CDI recurrence were female sex (odds ratio (OR), 2.26; 95% confidence interval (CI), 1.13 to 4.52), age > 75 years (OR, 2.69; 95% CI, 1.30 to 5.59), dialysis. (OR, 5.15; 95% CI, 1.45 to 18.27), vomiting at presentation (OR, 0.06; 95% CI, 0.01 to 0.55), wall thickening colic in the abdomen CT (OR, 2.42; 95% CI, 1.06 to 5.49) and treatment with vancomycin (OR 4.60, 95% CI 1.34-15.84).

The authors hope that their results will encourage higher uptake of fidaxomicin, bezlotoxumab and FMT in cancer patients with CDI.

“Although recurrence rates in these patients were significant, the use of fidaxomicin and other preventative measures was rare,” they wrote. “Importantly, we identified factors that may guide the initiation of such strategies in cancer patients.”