Epidemiology of Hospital-Acquired Gastroenteritis in Hematology/Oncology Patients: A Retrospective Cohort Study

Abstract

Background: Hospital-acquired gastroenteritis is a significant cause of morbidity and mortality among patients with cancer, particularly in hemato-oncology settings, owing to immunosuppression and prolonged hospital stays. However, data on the epidemiology and diagnostic performance of molecular assays for hospital-acquired gastroenteritis in this population remain limited. Objectives: This retrospective cohort study aimed to analyze the epidemiology of hospital-acquired gastroenteritis among patients with cancer at a tertiary-care academic hematology-oncology hospital. Methods: Patients who developed diarrhea > 72 hours after admission between March 1, 2020, and November 30, 2022, were included. Gastrointestinal (GI) multiplex polymerase chain reaction (PCR) panel (BioFire-bioMerieux, France) and stool culture results were extracted from electronic medical records. Results: The study included 50 patients (mean age, 57.9 ± 15.4 years; 58% female). Fourteen different pathogens were identified, most commonly Clostridioides difficile (n = 17), enteropathogenic Escherichia coli (n = 15), enteroaggregative E. coli (n = 12), and Salmonella spp. (n = 6). Non-Hodgkin lymphoma (n = 12) was the most common underlying malignancy. No significant difference in pathogen distribution was observed between the neutropenic and non-neutropenic groups. Overall 30-day mortality was 14%. When stool culture was considered the gold standard, the GI panel had a sensitivity of 100%. Conversely, when the GI panel was considered the gold standard, stool culture had a sensitivity of 55.5%. The agreement rate between stool culture and the GI panel was 55.5% (5 of 9). No pathogen overlap or clustering was observed within a ± 48-hour period of each gastroenteritis episode. Conclusions: The absence of temporal clustering suggests that these cases may not have resulted from a single point-source hospital outbreak. Although outsourced or home-prepared food may represent a potential secondary source of infection in this vulnerable population, prospective studies with dietary exposure tracking are required to confirm this association. We recommend reinforcing general food-safety protocols for both inpatients and outpatients.