Abstract
BACKGROUND: To investigate the impact of Clostridium difficile infection (CDI) on chemotherapy in patients with primary ovarian cancer. METHODS: This retrospective study included patients with primary ovarian cancer diagnosed with CDI at the National Cancer Center, Korea, between January 2014 and December 2023. Patients with gastrointestinal symptoms and positive C. difficile stool tests were included. The primary objective was to assess the impact of CDI on chemotherapy, and the secondary objective was to evaluate other clinical outcomes and risk factors associated with CDI. RESULTS: A total of 111 CDI episodes were identified in 90 patients, with 17 patients experiencing recurrent CDI. Among initial CDI episodes, 51.1% occurred during the first or second cycle of adjuvant chemotherapy after cytoreductive surgery. Adjuvant chemotherapy cycles were delayed in 81.1% of cases, with a median delay of 13 days. Additionally, 7.8% of patients discontinued chemotherapy, and CDI-related mortality was 2.2%. Severe or fulminant CDI was associated with higher rates of intensive care unit admission, bowel surgery, or death (38.9% vs. 4.2%; P < 0.001). Septic shock (odds ratio [OR], 8.40; 95% confidence interval [CI], 1.54-45.74; P = 0.014) and prolonged post-CDI antibiotic treatment (OR, 1.08; 95% CI, 1.01-1.15; P = 0.016) were linked to severe outcomes. CONCLUSION: CDI can cause chemotherapy delays and severe adverse outcomes, such as septic shock or death. Early identification of CDI and a multidisciplinary approach are essential to minimize CDI-related complications in patients with ovarian cancer. Further research is needed to develop preventive strategies and evaluate the long-term impact of CDI on cancer prognosis.