More Research Needed for CDI Variables for Cancer Patients

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Neutropenia, male gender, high serum creatinine, and albumin were all associated with fatal outcomes.

There is a need for more research furthering some of the variables associated with outcomes for patients with cancer and clostridiodes difficile infections (CDI).1

A team, led by Daniel De-la-Rosa-Martinez, Department of Infectious Diseases, Instituto Nacional de Cancerologia, evaluated the performance of scoring systems for severity and analyzed risk factors for mortality in a cancer cohort.

CDI and Cancer

C. difficile causes the release of various proinflammatory cytokines, including interleukin (IL)-1β, IL-8, IL-16, and IL-17A, and several other regulatory and anti-inflammatory cytokines, including IL-10, IL-23, and IL-48, some of which increase in states of inflammation and cancer.

Currently, there is no standard definitions for assessing the severity of CDI in patients with cancer.

In the observational study, the investigators examined patients with cancer and CDI and calculated the incidence of hospital-onset (HO-CDI) and community-onset health-care facility associated (CO-HCFA-CDI) episodes.

The team classified severity using 5 prognostic scales and calculated sensitivity, specificity, positive, and negative predictive values for mortality and intensive care unit admission. They also assessed variables associated with mortality using multivariate regression.

Incidence Rates

The HO-CDI incidence rate was 3.7 cases per 10,000 patient-days and CO-HCFA-CDI incidence rates was 1.9 cases per 1000 admissions.

Using the criteria set by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the investigators found the higher sensitivity (97%; 95% confidence interval [CI], 85–100%) for 30-day all-cause mortality. The results were similar for NPV (98%, 95% CI; 85–100%), while ATLAS (≥ 6 points) had the highest specificity (95%, 95% CI; 90–98%) for 30-day all-cause mortality.

There were similar performances found for intensive care unit admission.

They also found neutropenia (≤ 100 cells/ml) (aOR, 3.03; 95% CI, 1.05–8.74, P = 0.040), male gender (aOR, 2.90; 95% CI, 1.08–7.80; P = 0.034), high serum creatinine (aOR, 1.71; 95% CI, 1.09–2.70; P = 0.020), and albumin (aOR, 0.17; 95% CI, 0.07–0.42, P <0.001) were associated with fatal outcomes.

“Some of the current scales may not be appropriate to discriminate severity in patients with cancer,” the authors wrote. “The variables in this study associated with unfavorable outcomes could be evaluated in prospective studies to develop prognostic scores that identify susceptible patients, especially in immunocompromised populations.”

CDI and Prostate Cancer

Developing clostridiodes difficile infections (CDI) actually may lessen the risk of prostate cancer, according to research published earlier this month.

A team, led by Lexi R. Frankel, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, analyzed the effect of CDI on the risk of developing prostate cancer.

In the retrospective cohort analysis, the investigators searched a national database to evaluate the relationship between a prior history of CDI and subsequent development of prostate cancer between January 2010 and December 2019 of patients with and without a history of CDI.

The results show 2.56% (n = 1827) of the CDI group developed prostate cancer, compared to 7.79% (n = 5565) in the control group (P <2.2 × 10-16; OR, 0.390, 95% CI, 0.372-0.409).

The investigators then matched the patients by antibiotic exposure and found the prostate cancer incidence was 272 (1.62%) in the CDI group and 663 (3.95%) in the control group (P <2.2 × 10-16; OR, 0.467; 95% CI, 0.431-0.507).

The average time between treated C. difficile infection and PC diagnosis was 1000 days and the average time between the control group with treatment exposure and PC diagnosis was 1033 days.


De-la-Rosa-Martinez, D., Zinser-Peniche, P., Martin-Onraet, A. et al. Performance of Clostridioides difficile infection severity scores and risk factors related to 30-day all-cause mortality in patients with cancer. Support Care Cancer 31, 187 (2023).