Highlights
- •Gynecologic cancer patients are at increased risk of C. difficile infection (CDI).
- •Antibiotic use increases the risk of CDI, but the role of chemotherapy is unclear.
- •Depending on prevalence, a multi-step algorithm may improve diagnostic accuracy.
- •CDI treatment and prognosis varies by disease severity and number of prior episodes.
Abstract
Clostridium difficile infection (CDI) is a major cause of nosocomial diarrhea with the potential for significant
morbidity and mortality. Colonization in a susceptible individual, with risk factors
such as prior antibiotic use, advanced age, or medical comorbidities, may result in
symptomatic infection. Although patients with a gynecologic malignancy may be at a
higher risk of developing CDI due to an increased likelihood of having one or more
risk factors, data do not consistently support the idea that chemotherapy or cancer
itself are independently associated with CDI. For diagnosis of CDI, we recommended
using a multi-step approach, with a highly sensitive initial rapid test such as the
enzyme immunoassay (EIA) for glutamate dehydrogenase (GDH) or nucleic acid amplification
testing (NAAT), followed by confirmatory testing with of the above two tests or EIA
toxin A/B, which has high specificity. Treatment varies based on the severity of disease.
We recommend vancomycin as first-line therapy for an initial episode of mild/moderate
or severe CDI, with consideration of fidaxomicin for patients at particularly high
risk for recurrence. Rectal vancomycin may play an adjunctive role for some severe
cases, while surgical intervention is indicated for fulminant CDI if no improvement
six or more days after initiating medical therapy. For non-severe recurrent disease,
the initial treatment regimen should be repeated, while subsequent episodes are more
appropriately treated with a tapered and pulsed dose of vancomycin, fidaxomicin, or
fecal microbiota transplantation.
Keywords
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Article info
Publication history
Published online: November 19, 2016
Accepted:
November 12,
2016
Received in revised form:
November 8,
2016
Received:
August 23,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
