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Outcomes of Clostridioides difficile infection in adult cancer and non-cancer patients hospitalised in a tertiary hospital: a prospective cohort study
  1. Bojana Milenković1,
  2. Vesna Šuljagić2,3,
  3. Aneta Perić1,2,
  4. Viktorija Dragojević-Simić2,4,
  5. Olivera Tarabar2,5,
  6. Milomir Milanović2,6,
  7. Vesna Putić1,2,
  8. Diana Tomić7,
  9. Branislava Miljković8,
  10. Sandra Vezmar Kovačević8
  1. 1 Department of Pharmacy, Military Medical Academy, Belgrade, Serbia
  2. 2 Medical Faculty University of Defence, Belgrade, Serbia
  3. 3 Section for Prevention and Control of Nosocomial Infections, Military Medical Academy, Belgrade, Serbia
  4. 4 Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
  5. 5 Clinic for Haematology, Military Medical Academy, Belgrade, Serbia
  6. 6 Clinic for Infectious and Tropic Diseases, Military Medical Academy, Belgrade, Serbia
  7. 7 Institute of Microbiology, Military Medical Academy, Belgrade, Serbia
  8. 8 Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy University of Belgrade, Belgrade, Serbia
  1. Correspondence to Bojana Milenković, Department of Pharmacy, Military Medical Academy, 11000 Belgrade, Serbia; boxy87{at}


Background Clostridioides difficile infection (CDI) is one of the most common healthcare-associated (HA) infections. Cancer patients, particularly haemato-oncological patients, have an increased risk for CDI due to more risk factors compared with non-cancer patients. The aim of this study was to investigate differences in outcomes associated with HA CDI in patients with solid and haematological malignancies compared with patients with no underlying malignant disease in a tertiary healthcare centre in Serbia.

Methods A prospective cohort study was conducted including adult patients diagnosed with an initial episode of HA CDI. Their demographic and clinical characteristics associated with risk factors for CDI were documented. Outcomes such as all-cause 30-day mortality, cure of infection, diarrhoea relaps and recurrence of disease were followed. Patients were assigned to cancer and non-cancer groups. Within the cancer group, patients were divided into the solid tumour subgroup and haematological malignancy subgroup.

Results During a 7-year period, HA CDI was observed in 28 (5.1%) patients with haematological malignancy, 101 (18.3%) patients with solid tumours and 424 (76.7%) non-cancer patients. Older age (OR 1.04, 95% CI 1.02 to 1.07, p<0.001), admission to the intensive care unit (ICU) (OR 2.61, 95% CI 1.37 to 4.95, p=0.003), mechanical ventilation (OR 5.19, 95% CI 2.78 to 9.71, p<0.001) and use of antibiotics prior to CDI (OR 1.04, 95% CI 1.02 to 1.06, p=0.02) were associated with increased mortality. Compared with patients with solid tumours, patients with haematological malignancy were younger (65 vs 57 years, p=0.015), did not require ICU admission (25.0% vs 0%) or mechanical ventilation (8.9% vs 0%) and were treated longer with antibiotics prior to CDI (14 vs 24 days, p=0.002).

Conclusions Patients with haematological malignancy were exposed to different risk factors for CDI associated with mortality compared with patients with solid tumours and non-cancer patients. Older age, ICU stay and mechanical ventilation, but not presence or type of cancer, predicted the all-cause 30-day mortality.

  • drug-related side effects and adverse reactions
  • microbiology
  • clinical medicine
  • controlled clinical trial
  • education department
  • hospital
  • gastrointestinal neoplasms
  • head and neck neoplasms
  • hematology
  • kidney neoplasms
  • leukemia
  • multiple myeloma
  • transplantation
  • urologic neoplasms

Data availability statement

No data are available. All data relevant to the study are included in the article or uploaded as supplementary information. No data are available.

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