INCIDENCE OF DIARRHEA BY Clostridium difficile IN HEMATOLOGIC PATIENTS AND HEMATOPOIETIC STEM CELL TRANSPLANTATION PATIENTS: RISK FACTORS FOR SEVERE FORMS AND DEATH

We describe the rate of incidence of Clostridiumdifficile-associated diarrhea (CDAD) in hematologic and patientsundergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011,using two denominators 1,000 patient and 1,000 days of neutropenia and the riskfactors associated with the severe form of the disease and death. The ELISA method(Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identifyC. difficile. A multivariate analysis was performed to evaluatepotential factors associated with severe CDAD and death within 14 days after thediagnosis of CDAD, using multiple logistic regression. Sixty-six episodes wereidentified in 64 patients among 439 patients with diarrhea during the study period.CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acutemyeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (45%)undergone allogeneic HSCT, 61/64 (88%) had previously used antibiotics and 9/64 (13%)have severe CDAD. Most of the patients (89%) received treatment with oralmetronidazole and 19/64 (26%) died. The independent risk factors associated withdeath were the severe form of CDAD, and use of linezolid.