930. Risk Factors and Epidemiology of Clostridium difficile Infection in Hematopoietic Stem Cell Transplant Recipients During the Peri-transplant Period
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
Background:

Hematopoietic stem cell transplant (HSCT) patients are increasingly being diagnosed with Clostridium difficileinfection (CDI) over the last 34 years in the US. Our study focuses on identifying specific risk factors associated with developing CDI besides those already known such as age and type of transplant during the peri-transplant period.

Methods:

We performed a nested case-control study within a cohort of HSCT patients who received a transplant between November 2010 and March 2013. Eligible cases included those patients who had a clinical history compatible with CDI and a positive stool sample for C. difficile by GeneXpert. Eligible controls included patients transplanted during that period of time but with a negative C. difficiletest.  Each case was matched to 3 controls on gender, age (±5 years) and type of transplant except for 6 cases with only 2 controls.

Results:

We identified 86 cases and 252 controls (Table 1). Most common presenting symptoms of CDI were diarrhea (89%) and fever (55.8%). Ninety percent of the cases were diagnosed with CDI within the first month after HSCT (median time, 5 days; interquartile range [IQR] 3 to 8). Almost all cases were treated with oral vancomycin (97.6%).  Cases were more likely to have been hospitalized (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.12 – 3.07), or received chemotherapy (OR 3.29, 95% CI 1.93 – 5.62) in the previous 60 days before C. difficile test.  Mortality was significantly higher in the cases (13.9% vs 5.9%).

Conclusion:

Our study is unique given the high number of cases analyzed with a 3:1 match ratio and a diagnosis made by PCR. Most of our cases were diagnosed in the early post-transplant period. Prior hospital stay and administration of chemotherapy two months before testing were strong predictors for CDI

Table 1. Characteristics of cases and controls

Characteristics

Cases

(n=86)                             

 Controls

(n=252)

P value

Age in years

      Mean (SD)

53.2 (13.7)

53.8 (13)

0.71

Male gender, no (%)

 

52 (60.4)

151 (59.9)

0.92

Transplant type

       Autologous

       Allogeneic

               

61 (70.9)

25 (29)

183 (72.6)

69 (27.4)

0.83

Death (all causes)

12 (13.9)

15 (5.9)

0.018

Mucositis

21 (24.4)

72 (28.6)

0.45

CMV Disease

 

4 (4.6)

3 (1.2)

0.052

GVHD

 

7 (8.1)

13 (5.1)

0.31

Antibiotics*

 

83 (96.5)

244 (96.8)

0.8876

Hospitalized *

 

46 (53.5)

97 (38.5)

0.0152

Chemotherapy*

55 (63.4)

91 (36.1)

<0.001

* 60 days prior to C. difficile test

Sol Aldrete, MD1, Colleen Kraft, MD2,3, Matthew Magee, Ph.D.4, Austin Chan, MD5 and Rachel Friedman-Moraco, MD3, (1)Department of Medicine, Division of Infectious Diseaes, Emory University, Atlanta, GA, (2)Emory University School of Medicine, Atlanta, GA, (3)Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, (4)Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, (5)Department of Medicine, Divison of Infectious Diseases, Duke University, Durham, NC

Disclosures:

S. Aldrete, None

C. Kraft, None

M. Magee, None

A. Chan, None

R. Friedman-Moraco, None

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