430. Clostridium difficile Infection (CDI) in Cancer Pts: A Case-Control Study
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: An increase in CDI cases is seen over the past decade and multiple outbreaks due to a virulent strain of CDI (BI/NAP1/027) have been reported in many hospitals as well as in our institution in May’07. There is a lack of data on risk factors and outcome of CDI amongst cancer patients (pts)
Methods: There was an increase in CDI at our institution from May’07 to Sept’07 (0.38 in Feb’07 to 1.92/1000 pts-days in May’07, p<0.05). We evaluated 100 pts (Cases) during the outbreak and collected data on demographics, risk factors & outcome of CDI and compared it to 2 control groups of 100 pts each matched for age and cancer [positive control group (PCG): pts with CDI 2 y prior to the outbreak and the negative control group (NCG): pts who had diarrhea during the outbreak period but no CDI]
Results: Demographics and average length of the stay were similar between the 3 groups. When compared to NCG, cases had a higher APACHE score (14.1 vs. 11.9, p=0.04), were more likely to have a co-infection (54 vs. 39, p=0.04) with a trend of more likely to be on quinolones (65 vs. 52, p=0.08) and antacids (74 vs. 62, p=0.09) within 30 days of CDI. Thirty five cases had severe CDI as compared to 23 pts in PCG (p=0.08). Amongst the cases, pts with Leukemia were more likely to develop severe CDI (37% vs. 21% p=0.01), had a higher co-infection rate (70% vs. 21% p<0.01), relapse rate (14% vs. 5%, p=0.04) and APACHE score (14.2 vs. 9.6, p=0.03) as compared to pts with HSCT, with no difference in mortality. Amongst cases, pts with severe CDI were more likely to be transferred to the ICU (25% vs. 8% p=0.03) and die from CDI (22% vs. 6% p=0.02). When treated with metronidazole, cases with severe CDI had higher mortality (30% vs. 13%, p<0.01) and relapse rate (11% vs. 2.8%, p=0.04) as compared to pts on oral vancomycin.
Conclusion: During the outbreak, more cancer pts developed severe CDI which probably was due to the circulating BI/NAP1/027 strain at our institution. Patients with severe CDI had higher mortality and relapse rates especially if they were treated with metronidazole instead of vancomycin. We recommend the usage of Oral Vancomycin in cancer pts with severe CDI
Javier Adachi, MD1, Roy Chemaly, MD, MPH2, Herbert DuPont, MD, FIDSA3, Ray Hachem, MD4, Issam Raad, MD, Dhanesh Rathod, MD6, Jharna Shah, MD6, Karen Vigil, MD7 and  D. B. Rathod, None..
J. A. Adachi, None..
K. J. Vigil, None..
J. N. Shah, None..
H. DuPont, None..
R. Y. Hachem, None. 
I. Raad,
Cook, Inc. Role(s): Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Received: Educational Grant, Licensing Agreement or Royalty, Consulting Fee.
R. F. Chemaly, None., (1)Dept. of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX, (2)Infectious Diseases, Infection Control and Employee Health, University of Texas - MD Anderson Cancer Center, Houston, TX, (3)St. Luke's Episcopal Hospital and Kelsey Research Foundation and Kelsey-Seybold Clinic, Houston, TX, (4)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, (5)The University of Texas M. D. Anderson Cancer Center, Houston, TX, (6)M D Anderson Cancer Center, Houston, TX

Disclosures:

J. Adachi, None

R. Chemaly, None

H. DuPont, None

R. Hachem, None

I. Raad, None

D. Rathod, None

J. Shah, None

K. Vigil, None