1529. Clostridium Difficile Colonization and Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background:

There was an increase in the Clostridium difficile infection (CDI) rate in our bone marrow transplant unit.  In order to evaluate the role of cross-transmission, C. difficile screening was performed on patients admitted for hematopoietic stem cell transplantation (HSCT), patients were closely monitored for CDI, and C. difficile isolates were typed. 

Methods:

C. difficile testing was performed using a 2-step C. difficile glutamate dehydrogenase antigen plus toxin A/B EIA (QUIK CHEK) and cytotoxin assay (or toxin PCR).  A retrospective chart review was performed on all patients with a positive toxin assay.  Multilocus sequence typing (MLST) was performed on toxin-positive whole stool samples (Griffiths et al, J Clin Microbiol 2010;48:770).

Results:

Thirteen of 147 (8.8%) asymptomatic patients tested had toxigenic C. difficile colonization (CDC). The overall CDI rate within 100 days post-transplant was 24.6% (37/150). The mean day of onset of CDI was 5.8 ± 8 days post-HSCT.  The rate of CDI was significantly higher among CDC patients compared to non-CDC patients (OR 6.4; 95% CI 4 - 10.2).  MLST on 15 C. difficileisolates revealed 11 distinct types and failed to identify potential cross-transmission. 

Conclusion:

These data suggest that prior CDC, which is likely underestimated by a standard C. difficile assay, plays a major role in CDI rates in this high-risk patient population. As a result, universal contact isolation precautions have been implemented in the unit.

Jackrapong Bruminhent, MD, Zi-Xuan Wang, PhD, Carol Hu, MD, Richard Sunday, MS, Brent Bobik, BS, Seyfettin Alpdogan, MD, Matthew Carabasi, MD, Joanne Filicko-O'hara, MD, Neal Flomenberg, MD, Margaret Kasner, MD, Ubaldo Martinez-Outschoom, MD, John Wagner, MD, Mark Weiss, MD and Phyllis Flomenberg, MD, Thomas Jefferson University Hospital, Philadelphia, PA

Disclosures:

J. Bruminhent, None

Z. X. Wang, None

C. Hu, None

R. Sunday, None

B. Bobik, None

S. Alpdogan, None

M. Carabasi, None

J. Filicko-O'hara, None

N. Flomenberg, None

M. Kasner, None

U. Martinez-Outschoom, None

J. Wagner, None

M. Weiss, None

P. Flomenberg, None

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