961. Treatments and outcomes for Clostridium difficile infection (CDI) in patients with HIV infection
Session: Poster Abstract Session: Clostridium difficile Infections: Treatment and Prevention
Friday, October 9, 2015
Room: Poster Hall
Posters
  • ID 2015 poster C diff HIV.pdf (216.8 kB)
  • Background:

    Immunosuppression is a known risk factor for CDI. Limited data exists evaluating optimal CDI therapy in HIV patients and relapse rates are between 9-28%. The objectives of this study were to evaluate appropriateness of treatment based on severity of CDI, relapse and mortality in HIV infected patients.

    Methods:

    An IRB-approved, multicenter, retrospective chart review evaluating treatment and  outcome for CDI in HIV infected patients between 2010-2012. Data collected relevant to CDI and treatment outcomes included: demographics, severity, treatment, relapse, and mortality. Severity was defined according to IDSA guidelines.

    Results:

    Forty-six HIV patients with mean age of 48 were treated for CDI (81% female, median CD4 count 104 cells/mm3). Only 16/46 (35%) achieved viral suppression and 25/46 (54%) received opportunistic prophylaxis. Even though a majority of these patients were immunocompromised, 34/46 (74%) developed mild-moderate CDI and 12/46 (26%) developed severe CDI. No patients were classified as severe-complicated CDI. A total of 6/46 (13%) were not treated with an appropriate regimen according to IDSA guidelines of which one patient had relapse and one had died at the end of treatment. Median WBC was 5.8X103 cells/ml (IQR 3.9-10.9) and 14/46 (30%) developed a fever at the time of diagnosis. Relapse rate was 13% and an all-cause mortality rate of 6.5 %.

    No of Patients

    Cure

    Relapse

    Death

    Mild-Moderate CDI

    26

    6

    2

    Severe CDI

    11

    0

    1

    CD count <200 cells/mm3

    23

    4

    2

    Viral suppression (No of pa

    18

    4

    2

    Median WBC (IQR) X103 cells/ml

    8 (4.4, 11)

    5 (3.8, 4.0)

    12 (9.2, 15)

    Conclusion:

    Despite their immune status and CD4 count, mild-moderate CDI was common in HIV patients. Relapse rate was consistent with what the literature had reported in HIV patients. However, patients may be misclassified due to the impaired immune response. WBC may not be an appropriate criteria to determine severity of CDI.

    Siyun Liao, PharmD, PhD, University of Cincinnati Medical Center, Cincinnati, OH, Melissa Badowski, PharmD, Pharmacy, University of Illinois at Chicago, Chicago, IL, Robert Glowacki, PharmD, University of Illinois at Chicago, College of Pharmacy, Chicago, IL and Patricia Herrera, MD, Cook County Hospital, Chicago, IL

    Disclosures:

    S. Liao, None

    M. Badowski, None

    R. Glowacki, None

    P. Herrera, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.