Management of Clostridioides difficile infections in patients with hematological malignancies - a survey by European Conference on Infections in Leukemia (ECIL) and Infectious Diseases Working Party (IDWP) of The European Society for Blood and Marrow Transplantation (EBMT).

OBJECTIVES

Patients with hematological malignancies (HM) are particularly at risk of developing Clostridioides difficile infection (CDI). The 10th European Conference on Infections in Leukemia (ECIL-10) group developed recommendations for managing CDI in patients with HM, preceded by a survey to document current CDI practices.

METHODS

ECIL members completed an online expert survey on epidemiology, severity criteria, and diagnostic and therapeutic approaches to CDI. Rates were reported using the number of responses as the denominator.

RESULTS

Overall, 49 experts from different centers responded, including both hematologists and infectious disease specialists. The rate of CDI in adults with HM was 5-10% in 46% of centers and in children in 36% of centers. We identified important limitations in CDI severity definitions, with leukocytosis and hypoalbuminemia being the least useful criteria. Therapeutic choices in patients with HM were predominantly vancomycin, with fidaxomicin used less frequently. Metronidazole monotherapy was used despite data showing lower efficacy. For recurrent CDI, fidaxomicin was the preferred drug. For ≥2nd recurrence, 31% of centers used fecal microbiota transplantation.

CONCLUSIONS

The survey identified discrepancies in current practice and highlighted several unmet needs, including better-defined severity criteria, optimization of the use and duration of available agents, and access to intravenous agents for patients unable to take oral therapy.