Clostridium difficileinfection in patients with haematological malignant disease: Risk factors, faecal toxins and pathogenic strains

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Abstract
SUMMARY: Two hundred and forty-eight patients from shared oncology and general medical wards were prospectively studied over a 6-month period for carriage ofClostridium difficileduring an outbreak of clinical disease with an epidemic strain of the organism. Risk factors for infection were assessed. Acute leukaemia and/or its treatment were identified as significantly increasing the risk of infection.The relationship between the type ofC. difficileisolated (as defined by a typing system based on the incorporation of [35S]methionine into bacterial proteins followed by gel electrophoresis), the presence of faecal toxins A and B and clinical symptoms were analysed. Carriage of the epidemic strain, type X, had a significant association with symptoms amongst oncology patients, with two thirds of these patients having detectable faecal toxin A and one third detectable faecal toxin B. During an outbreak ofC. difficile-associated disease, typing the organism and assaying for both faecal toxins in symptomatic patients may be of benefit in determining which patients require specific, urgent treatment.