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

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. 


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).


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. 


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


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

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.