# Clinical Characteristics and Risk Factors for Clostridioides difficile Infection in the Hematopoietic Cell Transplantation Population

## TL;DR

This study identifies risk factors for Clostridioides difficile infection in patients undergoing hematopoietic cell transplantation, highlighting higher risks in allogenic recipients.

## Contribution

The study provides new insights into specific risk factors for primary and recurrent CDI in HCT patients, particularly emphasizing allogenic HCT and antibiotic use.

## Key findings

- 252 out of 2,725 HCT patients (9.3%) developed primary CDI within one year.
- Allogenic HCT recipients had a higher CDI incidence (17.8%) compared to autologous recipients (4.1%).
- Penicillin antibiotics, prior chemotherapy, and umbilical cord stem cells were independent risk factors for primary CDI.

## Abstract

Hematopoietic cell transplantation (HCT) recipients are at increased risk of developing primary and recurrent Clostridioides difficile infection (CDI). The objective of our study was to characterize the risk factors for primary and recurrent CDI in a large cohort of patients hospitalized for HCT.

We conducted a retrospective cohort study of adults who underwent HCT from 2010–2023 to analyze the epidemiology, timing, and risk factors for CDI. We compared patients who developed CDI with those who did not, controlling for patient demographics, comorbidities, transplant factors, medications, and laboratory values.

Of the 2,725 adults who underwent HCT, 252 (9.3%) developed primary CDI within one-year of transplantation. The incidence was higher among allogenic HCT recipients (17.8%) compared to autologous recipients (4.1%). Independent risk factors for primary CDI included receipt of penicillin antibiotics, prior chemotherapy, and umbilical cord stem cells. Receipt of macrolide antibiotics was an independent risk factor for recurrent CDI, while receipt of autologous HCT was associated with a reduced risk of both primary and recurrent CDI.

CDI presents an early complication after HCT, particularly in allogenic recipients who experience higher incidence rates and severe complications. Early recognition and management of these risk factors are essential to prevent these adverse outcomes.