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2 september 2019: Bron: Emerging Infectious Diseases. 2019;25(9):1683-1689

De bacteriele infectie Clostridiodes difficile infectie (CDI) veroorzaakt door de bacterie Clostridioides difficile of Clostridium difficile leidt vaak tot een grote problemen, vooral onder oudere mensen en mensen die een behandeling voor kanker ondergaan. De diarree die de bacterie veroorzaakt brengt vaak mensen in problemen die soms ook in een ziekenhuisopname resulteert en soms zelfs tot overlijden.

Uit een groot onderzoek onder totaal 93.566 deelnemers was 2,6% van de mensen opgenomen in het ziekenhuis voor een Clostridiodes difficile infectie (CDI) tijdens de studieperiode. Patiënten met kanker hadden vaker een CDI (2,8%) dan patiënten zonder kanker (2,4%). De onderzoekers analyseerden met leeftijdsintervallen van 5 jaar, en vonden een toename van het CDI-risico, van 1,9% bij patiënten van 66-69 jaar tot 2,9% bij patiënten> 85 jaar oud. Zie (Table 1)

Ik ga hier niet verder het studierapport vertalen, want is gratis in te zien en is Amerikaans pnderzoek dus wel wat anders dan in Nederland. Maar hoe deze bacterie en diarree veroorzaakt door de Clostridium difficile bacterie is te voorkomen of te behandelen staat o.a. in enkele artikelen op kanker-actueel. Met hoofdrol voor poeptransplantatie via neussonde en probiotica (zie daar in gerelateerde artikelen). Klik op deze search.

Het volledige studierapport: Risk for Clostridioides difficile Infection among Older Adults with Cancer is gratis in te zien.

Hier het abstract van de studie met referentielijst. 

Kamboj M, Gennarelli RL, Brite J, et al. Risk for Clostridioides difficile Infection among Older Adults with Cancer. Emerging Infectious Diseases. 2019;25(9):1683-1689. doi:10.3201/eid2509.181142.

Volume 25, Number 9—September 2019

Risk for Clostridioides difficile Infection among Older Adults with Cancer

Mini KambojComments to Author , Renee L. Gennarelli, Jennifer Brite, Kent Sepkowitz, and Allison Lipitz-Snyderman
Author affiliations: Memorial Sloan Kettering Cancer Center, New York, New York, USA (M. Kamboj, R.L. Gennarelli, J. Brite, K. Sepkowitz, A. Lipitz-Snyderman); Weill Cornell Medical College, New York (M. Kamboj, K. Sepkowitz)


To assess whether risk for Clostridioides difficile infection (CDI) is higher among older adults with cancer, we conducted a retrospective cohort study with a nested case–control analysis using population-based Surveillance, Epidemiology, and End Results–Medicare linked data for 2011. Among 93,566 Medicare beneficiaries, incident CDI and odds for acquiring CDI were higher among patients with than without cancer. Specifically, risk was significantly higher for those who had liquid tumors and higher for those who had recently diagnosed solid tumors and distant metastasis. These findings were independent of prior healthcare-associated exposure. This population-based assessment can be used to identify targets for prevention of CDI.


The main findings of our study, derived from a population-based cohort of Medicare beneficiaries >65 years of age, indicate that the risk for CDI is greater for older adults undergoing treatment for cancer than for age-matched controls. We show that much of this excess risk is associated with the type of underlying cancer and advanced disease and remains independent of prior healthcare-associated exposure from inpatient and skilled nursing facility stays. Risk was highest for patients with hematologic malignancies. In comparison, for solid tumor patients, odds of developing CDI were higher only for those with a recent cancer diagnosis and those with distant metastasis at diagnosis.

Our findings collectively expand knowledge of how cancer diagnosis affects CDI-associated illness among older adults. Reports of CDI in the absence of exposure to antimicrobial drugs has been well described for patients receiving cytotoxic chemotherapy (11), plausibly related to intestinal dysbiosis caused by these agents. In our study, the occurrence of CDI seemed to be influenced by active oncologic therapy among patients with solid tumors, as suggested by the heightened risk at the time of new diagnosis, when the intensity of treatment is expected to be greater. Similarly, the CDI risk for patients with solid tumors was also higher for those with distant site metastases at the time of diagnosis, underscoring the complexities in management of advanced cancers. We cannot determine from this study whether these associations are driven by type of cancer treatment, excessive use of antimicrobial drugs, or a consequence of immunologic and microbial perturbation associated with cancer treatment in persons of advanced age. We were unable to quantify antecedent exposure to antimicrobial drugs, a major driver of CDI (1215); the coexistence of several confounding factors makes this distinction particularly challenging. When we made risk adjustments for race, geographic region, type of healthcare facility, and number of prior healthcare facility stays, the odds of CDI in patients with liquid tumors were significantly higher. Similar to previous studies of non–cancer populations, we found an incremental increase in CDI risk with number of hospitalizations; risk for those with >3 hospital stays was 3-fold higher (12,16).

Symptoms of primary and recurrent CDI can be particularly debilitating in persons with advanced age and are frequently associated with postinfectious irritable bowel syndrome (5). In patients receiving concomitant cancer therapy, CDI symptoms are often indistinguishable from the gastrointestinal side effects of chemotherapy, radiation, and newer immunotherapies (17). For these complex reasons, CDI during cancer treatment can lead to delays in future chemotherapy or radiation cycles and have been shown to negatively affect eligibility for curative treatment options (18). In addition, the estimated surplus healthcare-associated costs of primary CDI in patients with advanced age is estimated to be around US $37,000 and for patients with immunocompromising conditions US $16,000, almost 2-fold higher than costs of CDI for patients without immunocompromising conditions (19). The wide-ranging effects of CDI in this population warrants assessment of primary prevention strategies (2022). Our study defines the subset of older adults with cancer who would probably benefit the most from such therapies to minimize the vulnerability to CDI during cancer treatment.

The strength of our study is that it provides population-based quantitative estimates of the differential effects of CDI among older adults with and without cancer. Despite the many advantages of the SEER-Medicare dataset, our study has limitations: we were able to measure CDI-related disease burden only in the hospital setting, and community-acquired (or community-onset) cases were not included unless they resulted in a hospitalization. Although we excluded patients who received a CDI diagnosis in 2010, case-patients do not necessarily represent those with primary infections. We used only the first Medicare claim with a CDI diagnosis; outpatient diagnoses would be missed and recurrent disease could potentially be represented as incident CDI. In addition, we did not measure relapsing CDI.

In summary, the burden of CDI among older adults is greater among those with underlying cancer. Regardless of prior healthcare-associated exposure, risk for CDI was highest for patients with hematologic malignancy and those with recent diagnosis of solid tumor or distant metastatic disease at diagnosis. These findings can be used to guide CDI prevention strategies.


Dr. Kamboj is an infectious disease physician and hospital epidemiologist at Memorial Sloan Kettering Cancer Center in New York, NY. Her research interests include the epidemiology of healthcare-associated infections in patients undergoing cancer treatment.



Funding for this study was provided by the National Institutes of Health, National Cancer Institute Cancer Center Support Grant P30 (CA008748).

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