C. difficile Potentially Dangerous for Colorectal Cancer Patients


Patients with preoperative colorectal cancer have reported high incidence rates of C. difficile.

Patients with preoperative colorectal cancer have reported high incidence rates of Clostridium difficile (C. difficile) infections.

To assess the correlation of the rate of C. difficile infection to clinical characteristics of colorectal cancer patients, a team of researchers from Memorial Sloan Kettering Cancer Center and China investigated the pattern of C. difficile colonization in preoperative colorectal cancer patients.

The researchers also wanted to understand the genotypes and antibiotic resistance profiles of the C. difficile strains in the 205 patients included in their study.

Of the included patients, the team found that16.1% (33 patients) were positive for C. difficile: 28 patients were positive for both tcdA and tcdB strains, while 4 were positive for tcdB only, and 1 patient was non-toxigenic with neither strain. The researchers only discovered 1 type of C. difficile isolate in each of the positive cultures from stool specimens.

For the 134 male patients, the colonization rate was 15.7%, compared to the 71 female patients’ rate of 16.9%. The average ages of the toxigenic C. difficile positive and negative patients were 64.1 years and 62.2 years, respectively, and the researchers added there was a tendency of higher C. difficile colonization rates in patients over the age of 60 years. However, there did not appear to be a colonization preference found between the different right- and left sided colorectal cancer patients.

The researchers noted that OB Negative patients had a higher rate of colonization of C. difficile. One possible reason the investigators provided was that bleeding from the cancer lesions could hinder C. difficile colonization or infection.

Interestingly, it did not appear that C. difficile status affected hospitalization duration. For the 172 patients in the study who were negative for C. difficile, the researchers determined they spent an average of 15.4 days in the hospital. The patients who tested positive for C. difficile were in the hospital for an average of 15.0 days.

The researchers tested the 33 C. difficile isolates against 12 antibiotics and found that all isolates were susceptible to vancomycin and metronidazole. Only 1 of the isolates was resistant to piperacillin-tazobactam. Patients with rectum cancer bore more fusidic acid-resistant C. difficile isolates than those with colon cancer. In addition, older patients (those more than 60 years) carried more moxifloxacin susceptible isolates than their younger counterparts.

Because lymph node metastasis colorectal cancer patients typically require chemotherapy, and because C. difficile infection may half that ongoing treatment, the researchers explained, sustained monitoring of C. difficile in these patients is crucial.

According to the researchers, it is accepted that the barrier provided by the gut microbiota prevents C. difficile colonization in the large intestine; however, when this is weakened by cancer, the risk of infection can increase. Thus, the researchers said, changes in the gut microbiota composition can lead to homeostasis instability, leading to inflammation, dysplasia, and carcinogenesis. Particularly in colorectal cancer patients undergoing chemotherapy, the development of C. difficile infection can lead to severe diarrhea, halting the chemotherapy process.

“Perioperative screening and monitoring for C. difficile is of great importance in these patients in order to avoid discontinuation of chemotherapy due to severe diarrhea and postoperative complications,” the study authors concluded.

The paper, “Clostridium difficile colonization in preoperative colorectal cancer patients,” was published in the journal Oncotarget.

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Timothy Wilt, MD, MPH | Credit: ACP
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