We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematologic and patients undergone 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 risk factors 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 identify C. difficile. A multivariate analysis was performed to evaluate potential factors associated with severe CDAD and death within 14 days after the diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were identified 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 from 0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute myeloid 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 oral metronidazole and 19/64 (26%) died. The independent risk factors associated with death were the severe form of CDAD, and use of linezolid.
Descrevemos a taxa de incidência de diarreia associada a Clostridium difficile (CDAD) em pacientes hematológicos e submetidos a transplante de células-tronco hematopoiéticas (TCTH) internados no HC-FMUSP no período de janeiro de 2007 a junho de 2011 usando dois denominadores 1.000 paciente e 1.000 dias de neutropenia e os fatores de risco associados à forma grave da doença e morte. O método de ELISA (Ridascreen-Biopharm, Germany) de detecção de toxinas A/B foi utilizado para o diagnóstico de C. difficile. Análise multivariada usando regressão logística múltipla foi conduzida para avaliar os potenciais fatores de risco associados com forma grave de CDAD e morte em até 14 dias do diagnóstico. Sessenta e seis episódios foram identificados em 64 pacientes entre 439 pacientes que apresentaram diarreia durante o período do estudo. A taxa de incidência de CDAD variou de 0,78 a 5,45 por 1.000 dias de neutropenia e de 0,65 para 5,45 por 1.000 pacientes-dias. A doença de base mais comum foi leucemia mielóide aguda 30/64(44%), 32/64 (46%) pacientes estavam neutropênicos, 31/64 (45%) foram submetidos à TCTH alogênico, 61/64 (88%) usaram antibióticos previamente e 9/64 (13%) apresentaram forma grave da doença. A maioria dos pacientes (89%) utilizou metronidazol oral no tratamento da CDAD e 19/64 (26%) evoluiram para óbito. Os fatores de risco independentes associados à morte foram forma grave da doença e uso de linezolida.