627. Prospective Evaluation of Toxigenic and Non-toxigenic Strains of Clostridium difficile Colonization and Infection among Allogenic Hematopoietic Stem Cell Transplant Recipients, 2010-2012
Session: Oral Abstract Session: Infections in Transplantations and Immunocompromised
Friday, October 4, 2013: 8:45 AM
Room: The Moscone Center: 220-226
Background:

Clostridium difficile (CD) is the leading cause of nosocomial diarrhea. After acquisition of CD, some patients (pts) remain colonized whereas others develop symptomatic CD infection (CDI). Hematopoietic stem cell transplant (HSCT) recipients are at much higher risk of CDI than the general population. Rates of colonization and acquisition of CD in the HSCT population are unknown. The objective of this study was to determine the rates of CD acquisition, CD colonization, and CDI in HSCT pts at our institution.

Methods:

We conducted a 16-month prospective study starting in December 2010 in the HSCT unit at the Karmanos Cancer Center. Pts who signed informed consent had stool samples collected within 72 hours of admission and weekly thereafter until discharge. Stool samples were anaerobically cultured for CD.  Culture positive samples were tested by PCR for confirmation of toxigenic CD. Demographic information, risk factors and outcomes were examined. All pts were followed up for 90 days after enrollment.

Results:

156 subjects were enrolled. After the initial stool sample obtained at admission from all pts, additional weekly samples were obtained from 65%, 47%, 39% and 15% of the pts at week 2, 3 and 4 respectively. The mean age was 54 years (range 19-68 yrs), 59% were males, and 99% had received an allogeneic HSCT. Overall 49/156 (31%) pts were colonized with CD at admission; 23/156 (14%) with toxigenic CD. Six of the toxigenic CD strains were the North American pulse field type 1 strain (NAP-1). Among pts colonized with toxigenic CD, 7/23 (30%) developed symptomatic CDI compared to 0/26 pts colonized with non-toxigenic CD (p = 0.002). Of pts not colonized at admission, 8/107 (7%) acquired nosocomial CD. Median time to acquisition was week 2 of hospitalization.

Conclusion:

Colonization with CD is high in our HSCT recipients upon admission. Development of symptomatic CDI is common (30%) in pts colonized with toxigenic CD; colonization with non-toxigenic CD may have a protective effect. The high rates of colonization with toxigenic CD may necessitate active surveillance in this population, to guide infection control measures, and possibly “pre-emptive” therapy to prevent symptomatic CDI.

Tania Jain, MBBS1, Christopher Croswell, BA2, Harsha Vardhan Reddy Banavasi, MBBS3, Varinia Urday-Cornejo, MD4, Alyssa Liubakka2, Jessica Cutright, BS2, Hossein Salimnia, PhD5, Paul Lephart, PhD6, Sanjay Revankar, MD7, Pranatharthi Chandrasekar, M.D.4, Teena Chopra, MD, MPH8 and George Alangaden, MD9, (1)Internal Medicine, Wayne State University/ Detroit Medical Center, Detroit, MI, (2)School of Medicine, Wayne State University, Detroit, MI, (3)Wayne State University, Detroit, MI, (4)Infectious Diseases, Wayne State University, Detroit, MI, (5)Detroit Medical Center/Wayne State University, Detroit, MI, (6)Detroit Medical Center University Laboratories, Detroit, MI, (7)Infectious diseases, Wayne State University, Detroit, MI, (8)Detroit Medical Center/ Wayne State University, Detroit, MI, (9)Infectious Diseases, Henry Ford Health System, Detroit, MI

Disclosures:

T. Jain, None

C. Croswell, None

H. V. R. Banavasi, None

V. Urday-Cornejo, None

A. Liubakka, None

J. Cutright, None

H. Salimnia, None

P. Lephart, None

S. Revankar, None

P. Chandrasekar, None

T. Chopra, None

G. Alangaden, None

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