Background: Anti-motility agents have typically been avoided in patients with Clostridium difficile diarrheal infections (CDI) due to fear of gastrointestinal complications such as toxic mega-colon. However, severe diarrhea, such as chemotherapy-related diarrhea, can result in significant adverse consequences to patients, such as volume loss and electrolyte depletion. We conducted a single-center observational study of patients in the malignant hematology service who developed CDI, and describe use and outcomes of anti-motility agents in this population.
Methods: We used the electronic health record to identify patients who were hospitalized in the adult malignant hematology service and who had >1 positive C. difficile toxin stool assay between July 1, 2012 and November 1, 2015. We manually reviewed medical charts to obtain information on use of anti-motility agents, clinical conditions, any subsequent in-hospital gastrointestinal complications, and these data were subsequently analyzed.
Results: There were 171 patients who screened positive for CDI during the study period. Of those, 42 patients (24.6%) were prescribed an anti-motility agent within 14 days following CDI diagnosis, with 17 patients receiving an anti-motility agent within 72 hours of CDI diagnosis . All patients received appropriate antimicrobial treatment for CDI within the first 24 hours. A total of 14 patients received autologous stem cell transplants during the CDI admission, 7 patients received allogeneic stem cell transplants, and 19 patients received chemotherapy but were not transplanted during the admission. Mean age was 58.5 years and mean length of stay was 26 days (13-119). Gastrointestinal complications were identified in 4 out of the 42 patients given anti-motility agents, none of which were considered related to anti-motility use: 1 with bright red blood per rectum 4 days after CDI positive stool collection, 2 patients were diagnosed with typhilitis, and 1 patient was diagnosed with jejunitis and ileus-attributed to bile acid reflux. There were no diagnosed episodes of toxic mega-colon based on chart review.
Conclusions: We found that anti-motility agents are sometimes given within the first 14 days of CDI diagnosis among a population of hematologic malignancy patients. In our cohort of 42 patients, we found no gastrointestinal complications related to use of anti-motility agents.
To cite this abstract:Kuon, CP; Graff, L; Lo, M; Tan, MD; Bliss, C; Prasad, P . ANTIMOTILITY USE IN PATIENTS WITH C DIFFICILE–POTENTIALLY SAFE?. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 84. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/antimotility-use-in-patients-with-c-difficile-potentially-safe/. Accessed April 5, 2020.