Management of Clostridioides difficile infection in patients with haematological malignancies and after cellular therapy - guidelines from 10th European Conference on Infections in Leukaemia (ECIL-10)

Oct 5, 2026

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Clostridioides difficile infection (CDI) is a major clinical challenge in patients with haematological malignancies (HM) and those receiving cellular therapies, including haematopoietic cell transplantation (HCT) and CAR T-cell therapy. These patients face high rates of colonization and diarrhoea from both infectious and noninfectious causes, complicating diagnosis and treatment, particularly when toxin gene molecular tests are used alone. ECIL-10 reviewed evidence from 2010-01-01 to 2024-09-15 and issued consensus management recommendations. It also proposed standardized definitions for proven, probable, and possible CDI to support consistent reporting in clinical research.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Summary

Key clinical challenges in this population

Evidence review and consensus recommendations

Standardized CDI definitions for research

Introduction

Colonization vs infection and epidemiology

Archive ouverte UNIGE [https://archive-ouverte.unige.ch](https://archive-ouverte.unige.ch) This is the published version of the publication, made available in accordance with the publisher’s policy. Management of Clostridioides difficile infection in patients with haematological malignancies and after cellular therapy : guidelines from 10th European Conference on Infections in Leukaemia (ECIL-10) Mikulska, Malgorzata; Robin, Christine; Neofytos, Dionysios; Oltolini, Chiara; Piekarska, Agnieszka; Reigadas, Elena; Gil, Lidia; Chemaly, Roy F.; Groll, Andreas H.; Muñoz, Patricia; Teh, Benjamin W. How to cite MIKULSKA, Malgorzata et al. Management of Clostridioides difficile infection in patients with haematological malignancies and after cellular therapy : guidelines from 10th European Conference on Infections in Leukaemia (ECIL-10) . In: EClinicalMedicine, 2025, vol. 87, p. 103371. doi: 10. 1016/j.eclinm. 2025.103371 This publication URL: [https://archive-ouverte.unige.ch/unige:191040](https://archive-ouverte.unige.ch/unige:191040) [Publication DOI:](Publication DOI: 10.1016/j.eclinm.2025.103371)[ 10.1016/j.eclinm.2025.103371](Publication DOI: 10.1016/j.eclinm.2025.103371) © The author(s) . This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND 4 .0) [https://creativecommons.org/licenses/by-nc-nd/4.0](https://creativecommons.org/licenses/by-nc-nd/4.0) Last update in Archive ouverte UNIGE on 27.01.2026 16:47 Review Management of Clostridioides difficile infection in patients with haematological malignancies and after cellular therapy: guidelines from 10th European Conference on Infections in Leukaemia (ECIL-10) Malgorzata Mikulska,a,b,∗ Christine Robin,c Dionysios Neofytos,d Chiara Oltolini,e Agnieszka Piekarska,f Elena Reigadas,g,h Lidia Gil,i Roy F. Chemaly,j Andreas H. Groll,k Patricia Muñoz,g,h and Benjamin W. Tehl,m aDivision of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy bDivision of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy cDepartment of Hematology, APHP Henri Mondor University Hospital, Créteil, France dDivision of Infectious Diseases, Transplant Infectious Disease Unit, University Hospital of Geneva, Geneva, Switzerland eASST Grande Ospedale Metropolitano Niguarda, Milan, Italy fDepartment of Hematology and Transplantology, University Clinical Centre, Medical University of Gdansk, Gdansk, Poland gDepartment of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain hDepartment of Medicine, School of Medicine, University Complutense of Madrid, Madrid, Spain iDepartment of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Pozna´n, Poland jDepartment of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA kInfectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children’s Hospital, Münster, Germany lDepartment of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia mSir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia Summary Clostridioides difficile infection (CDI) poses a significant challenge in patients with haematological malignancies (HM) and those undergoing cellular therapy such as haematopoietic cell transplantation (HCT) or CAR T-cell therapy. These patients have high rates of both colonization with Clostridioides difficile and diarrhoea due to noninfectious causes, leading to challenges with establishing diagnosis and optimal management of CDI, especially in the setting of molecular detection of toxin genes alone. Current severity criteria are of limited usefulness since underlying haematological disease and its treatment impact white bloo

FAQs

Why is CDI diagnosis difficult in patients with haematological malignancies and after cellular therapy?

These patients have high rates of both Clostridioides difficile colonization and diarrhoea from noninfectious causes, making it hard to distinguish infection. Diagnosis is further complicated when toxin gene molecular detection is used alone.

What limitations affect current CDI severity criteria in this setting?

Severity criteria have limited usefulness because underlying haematological disease and its treatments influence white blood cell counts and inflammatory features, which can distort assessment of severe CDI.

What did the ECIL-10 group do to address CDI management for this population?

The ECIL-10 group comprehensively reviewed literature from 2010-01-01 to 2024-09-15 on epidemiology, treatment, and prevention of CDI. It then formulated consensus recommendations tailored to patients with HM and after cellular therapy.

What definitions were developed for CDI in clinical research?

New definitions for proven, probable, and possible CDI were developed and proposed to standardise reporting in clinical research for this specific patient population.

Oct 5, 2026

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