{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:14:51Z","timestamp":1765232091822},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,8,27]],"date-time":"2013-08-27T00:00:00Z","timestamp":1377561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Clostridium difficile<\/jats:italic> infection (<jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content>) is a serious complication of chemotherapy including high\u2010dose regimens with autologous stem cell transplantation (<jats:styled-content style=\"fixed-case\">ASCT<\/jats:styled-content>). Antiperistaltic agents are contraindicated in <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> and preemptive <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> therapy is not recommended. We assessed the incidence, risk factors, and outcomes of <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> in patients with newly diagnosed multiple myeloma (<jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content>) receiving similar antineoplastic therapy and supportive care including antiperistaltic agents and preemptive <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> antibiotics for significant diarrhea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 303 consecutive <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> patients (2004\u20132007) were enrolled in a protocol consisting of induction chemotherapy, tandem melphalan (<jats:styled-content style=\"fixed-case\">MEL<\/jats:styled-content>)\u2010<jats:styled-content style=\"fixed-case\">ASCT<\/jats:styled-content>, and consolidation. Patients with grade 2\u20134 diarrhea were simultaneously tested for <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content>, and initiated on antiperistaltic agents (loperamide) and preemptive anti\u2010<jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> therapy. Risk factors, including prior <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> immunoglobulin (Ig) isotype, were evaluated. Multinomial logistic regression was used to compute the relative risk ratio (<jats:styled-content style=\"fixed-case\">RRR<\/jats:styled-content>) and 95% confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>s).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 43 cases of <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> (14.2%) during 1529 chemotherapy courses (536 <jats:styled-content style=\"fixed-case\">ASCT<\/jats:styled-content>). IgA <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> protected against <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">RRR<\/jats:styled-content> 0.35; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.13\u20130.93, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04) whereas <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> during first induction markedly increased the risk of recurrence during second induction (<jats:styled-content style=\"fixed-case\">RRR<\/jats:styled-content>\u00a0=\u00a010.94; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.90, 62.92, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.01) and following <jats:styled-content style=\"fixed-case\">MEL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">ASCT<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">RRR<\/jats:styled-content>\u00a0=\u00a06.63; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.51, 29.12, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.01). No <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content>\u2010related surgical intervention or death ensued despite use of antiperistaltic agents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> was not uncommon in cancer patients receiving chemotherapy. IgA myeloma appears to be protective. Concurrent antiperistaltic (loperamide) and preemptive <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> therapies were associated with excellent outcomes. Prior <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> history increased the risk for recurrence during successive chemotherapy courses.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.12112","type":"journal-article","created":{"date-parts":[[2013,8,27]],"date-time":"2013-08-27T08:14:33Z","timestamp":1377591273000},"page":"493-501","source":"Crossref","is-referenced-by-count":13,"title":["Risk factors, preemptive therapy, and antiperistaltic agents for <i><scp>C<\/scp>lostridium difficile<\/i> infection in cancer patients"],"prefix":"10.1111","volume":"15","author":[{"given":"S.G.","family":"Krishna","sequence":"first","affiliation":[{"name":"Myeloma Institute for Research and Therapy University of Arkansas for Medical Sciences Little Rock Arkansas USA"},{"name":"Department of Gastroenterology, Hepatology and Nutrition Ohio State University Medical Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W.","family":"Zhao","sequence":"additional","affiliation":[{"name":"Myeloma Institute for Research and Therapy University of Arkansas for Medical Sciences Little Rock Arkansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.K.","family":"Apewokin","sequence":"additional","affiliation":[{"name":"Myeloma Institute for Research and Therapy University of Arkansas for Medical Sciences Little Rock Arkansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Krishna","sequence":"additional","affiliation":[{"name":"Myeloma Institute for Research and Therapy University of Arkansas for Medical Sciences Little Rock Arkansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Chepyala","sequence":"additional","affiliation":[{"name":"Myeloma Institute for Research and Therapy University of Arkansas for Medical Sciences Little Rock Arkansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.J.","family":"Anaissie","sequence":"additional","affiliation":[{"name":"Myeloma Institute for Research and Therapy University of Arkansas for Medical Sciences Little Rock Arkansas USA"},{"name":"Division of Hematology Oncology University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,8,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/651706"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/592981"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/322616"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2010.01331.x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1702627"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2011.049627"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1702086"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/24.3.324"},{"issue":"9","key":"e_1_2_6_10_1","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1001\/archinternmed.2010.73","article-title":"Proton pump inhibitors and risk for recurrent Clostridium difficile infection","volume":"170","author":"Linsky A","year":"2010","journal-title":"Arch Intern Med"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012413"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2005.01.003"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/523582"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2008.12.003"},{"issue":"7","key":"e_1_2_6_15_1","first-page":"681","article-title":"Clostridium difficile\u2010associated diarrhea and chronic renal insufficiency","volume":"95","author":"Yousuf K","year":"2002","journal-title":"South Med J"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.12.038"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200002103420604"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)83393-1"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1086\/430315"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907635"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1086\/596711"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25633"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.jncimonographs.a003437"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2003.07696.x"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-11-255620"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044097"},{"key":"e_1_2_6_27_1","unstructured":"NCI.Common Terminology Criteria for Adverse Events v3.0 (CTCAE). 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