Incidence and outcome of Clostridium difficile infection following autologous peripheral blood stem cell transplantation

A retrospective evaluation of 200 consecutive recipients of autologous peri pheral blood stem cell transplantation (PBSCT) was conducted to ascertain t he incidence and outcome of infection with Clostridium difficile, The diagn osis was confirmed in 14 patients with diarrhea (15 episodes) at a median o f 33 days after stem cell infusion. Five patients were neutropenic at the t ime of diagnosis, Every individual had adverse known risk factors such as r ecent or current use of antibiotic, corticosteroid and antiviral therapy, r ecent administration of myeloablative chemotherapy and numerous, prolonged periods of hospitalization. Diarrhea, frequently hemorrhagic, was the most common presenting feature along with fever, abdominal cramps and abdominal distention, Diagnosis was established by the stool-cytotoxin test. Response to standard treatment with oral vancomycin or metronidazole was prompt des pite the presence of several adverse prognostic features in these patients. There was only one instance of relapse which was also treated successfully . Several transplant-related variables such as age, sex, underlying maligna ncy, myelo-ablative regimen, duration of neutropenia, and prophylactic use of oral ampicillin underwent statistical analysis but failed to be predicti ve of C. difficile infection in such a setting. Finally, C. difficile is no t uncommon after autologous PBSCT and must be included in the differential diagnosis in any such patient with diarrhea.