ahmoud Mansour, MD

Mahmoud Mansour, MD, Family and Community Medicine Fellow, School of Medicine, University of Missouri

Among patients with leukemia admitted to the hospital with Clostridioides difficile infection (CDI), those with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) have considerably higher adjusted odds of mortality, hospital charges, and length of stay (LOS), according to a study presented by Mahmoud Mansour, MD, at the 2022 American Society of Clinical Oncology (ASCO) Proceedings—Hematologic Malignancies at ASCO’s Annual Meeting.

“CDI is the most common cause of nosocomial diarrhea and the incidence and severity of CDI have increased in adults,” Dr. Mansour wrote. “However, CDI has not been well studied in patients with leukemia in recent years.” Dr. Mansour and colleagues sought to evaluate incidence, healthcare burden, and mortality in patients with ALL, AML, chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML).

CDI Incidence Higher in Patients With AML & ALL Compared With General Population

The study team utilized the Nationwide Inpatient Sample to analyze hospitalization data of patients admitted between January 1, 2016 and December 31, 2019. They identified adults with a diagnosis of CDI at discharge and a concomitant diagnosis of leukemia; the control group consisted of non-leukemia patients. The primary outcome was in-hospital mortality, while secondary outcomes were hospital charges and LOS.

During the study period, more than 1.2 million patients with CDI were admitted to hospitals. CDI incidence per 100 discharges was higher among leukemia patients, particularly in patients with AML and ALL (4.1 and 3.6, respectively) versus 1 in the general population. AML and ALL were independently linked with increased odds of mortality (adjusted OR, 2.19 and 1.90, respectively; P<0.01) after adjusting for comorbidities and demographic variables. Additionally, compared with non-leukemia patients, both AML and CML had a notable mean increase in LOS (7.2 and 3.1 days respectively; P<0.01) and hospital charges ($115,245 and $87,198, respectively; P<0.01).

“Applying antibiotic stewardship and appropriately diagnosing and treating CDI is pertinent in these high-risk patients,” Dr. Mansour stated.