Abstract
Objectives: Patients with concomitant diseases, particularly malignancies, are at significant risk for Clostridioides difficile infection (CDI). However, very little is known about the association between malignancy and CDI. Therefore, we evaluated the association of CDI in patients with different kinds of malignancies compared to control patients.
Methods: Patients (n=1022) with specific malignancies (496 patients, 328 men), subgrouped as Adenocarcinoma (AC), Hematological malignancies (HM), Multiple myeloma (MM), Pediatric solid tumor (PST), and controls (526 controls, 325 men) without any specific diseases were enrolled in the study. Laboratory data of the patients were reviewed for demographics, antibiotic exposure, clinical symptoms, and fecal Clostridioides difficile toxin (CDT) assay.
Results: Of 1022 patients, 805 received antibiotics. CDT was positive in 168 (80.0%) of those receiving antibiotics and in 42 (20.0%) not receiving antibiotics (p<0.001). Bloody diarrhea was present in 12.4% with CDT status. CDI among patients with malignancy (21.2%) and controls (20.0%) was insignificant (p=0.689). CDT was positive in 7/25 PST (28.0%), 24/96 AC (25.0%), 71/332 HM (21.4%) and 3/43 MM (7.0%) patients, but was not significant (p>0.05). Correlation of different malignant conditions with control and among themselves showed male gender in AC (p=0.039) and HM (p=0.003), antibiotic exposure in MM (p<0.001) and fever in PST and HM subgroups to be significant (p<0.001).
Conclusion: CDT positivity was higher in males and patients exposed to antibiotics. No significant association of CDT was seen in malignant patients compared to the controls, though patients in PST and AC subgroups were more prone to CDI. J Microbiol Infect Dis 2021; 11(3):124-131.

Key words: Clostridioides difficile infection, Hematologic malignancy, Adenocarcinoma, Multiple myeloma, Pediatric solid tumor