Incidence of CDI in a Cohort of US Patients with Newly Diagnosed Acute Myeloid Leukemia Receiving Intensive Chemotherapy

Background: The immunosuppression seen in Acute Myeloid Leukemia (AML) patients due to the intensive chemotherapy and consolidation therapies used to treat them is often associated with prolonged episodes of neutropenia. This immediately triggers the use of broad-spectrum antibiotics leading to a profound disruption of the gut microbiota that can persist for months. This dysbiosis increases the risk of Clostridioides difficile infection (CDI), the most common cause of healthcare associated infectious diarrhea.

Aim: The objective of the present study was to assess the anticipated incidence of CDI in patients newly diagnosed with AML and receiving intensive chemotherapies.

Methods: A retrospective analysis was conducted using databases of Truven Health Analytics^®. Comprehensive hospitalization data of US patients undergoing induction chemotherapy due to AML were analyzed to detect the incidence of CDI during or after the hospitalization with induction chemotherapy. C. difficile infections were detected through the use of the corresponding 008.45 (ICD-9-CM) or A04.7 (ICD-10-CM) codes in the diagnoses reported in the database records.

Findings: Out of the 81,033 patients diagnosed with hematologic diseases between January 2014 and December 2017 found in the dataset, 1,092 patients were included in the study. The incidence of CDI in the 180 days prior to hospitalization was 0.6%. The in-hospital incidence of CDI was 5.4% and increased to 11.9% at 120 days and 16.1% at 1 year after the start of the intensive chemotherapy.

Conclusions: CDI frequently complicates the care of patients with AML during and after the induction chemotherapy and is to be monitored closely in hospital wards managing patients with hematologic diseases.