932. Risk Factors for Recurrent Clostridium difficile Infection among Allogenic Stem Cell Transplant Recipients
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
Background: Allogeneic stem cell transplantation recipients (allo-SCT) are highly vulnerable to Clostridium difficile infection (CDI) due in part to their exposure to known risk factors such as antimicrobial drugs, proton pump inhibitors (PPI), and corticosteroids. We aimed to evaluate clinical factors associated with recurrent disease among a cohort of allo-SCT recipients at the NIH Clinical Center, a 240-bed clinical research hospital.

Methods: We conducted a retrospective study of all patients who underwent allo-SCT from 1/2010 to 7/2013 and had CDI within 6 months of transplantation. We collected clinical data through medical record review, including conditioning regimen, antibiotics, PPI, symptoms at the time of initial CDI, colonization with vancomycin-resistant Enterococcus (VRE) and acute graft versus host disease (aGVHD) of the gut. Data were analyzed using chi-square/Fisher’s exact tests, t-tests, and logistic regression modeling.

Results: Among 300 patients who underwent allo-SCT, 90 patients (30%) had at least one episode of CDI. Excluding 27 whose episodes occurred prior to beginning the conditioning regimen or more than 6 months post-transplant, 63 patients (21%) were included in this analysis. 21 (33%) had recurrent CDI. Patients who had recurrent vs. single episode CDI were similar in PPI, antibiotic, and corticosteroid use one month prior to the initial episode. Similarly, no differences were detected in fever, ICU admissions, and neutrophil/lymphocyte counts at the time of initial CDI episodes. 

A higher proportion of patients who had recurrences also had aGVHD of the gut (57% vs. 31%; p=0.045). Multivariable analysis demonstrated that VRE colonization was strongly predictive of CDI recurrence following an initial episode (OR=15.1, 95% CI 3.7-61.8; p=0.0002).  

Conclusion: In this cohort of patients, the incidence of CDI and recurrent CDI in the first 6 months following allo-SCT were high. The role of VRE colonization as a risk factor for CDI recurrence may relate to increased antibiotic exposure among MDRO-colonized patients. The relationship between CDI and aGVHD of the gut is intriguing and merits further exploration, as aGVHD is a major cause of post-transplant morbidity and mortality.

Marcela Ferrada, M.D., Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, MD; Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, Ninet Sinaii, Ph.D., M.P.H., Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, MD, David K. Henderson, M.D., National Institutes of Health Clinical Center, Bethesda, MD and Tara N. Palmore, M.D., Hospital Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, MD

Disclosures:

M. Ferrada, None

N. Sinaii, None

D. K. Henderson, None

T. N. Palmore, None

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