1849. Survey of Clostridium difficile Prescribing Practices for Hematology/Oncology Patients
Session: Poster Abstract Session: Treatment of HAIs/Antimicrobial Resistant Infections
Saturday, October 10, 2015
Room: Poster Hall
Background: Hematology/oncology (H/O) patients have increased risk for C. difficile-associated diarrhea (CDAD).Current IDSA/SHEA CDAD guidelines stratify infection severity and treatment by serum creatinine (SCr) and white blood cell count (WBC) but may not apply in this population. Expert opinion often drives CDAD treatment and varies between institutions but the degree of therapeutic variability is not known.

Methods: A self-administered case-based questionnaire was developed to characterize prescribing practices for CDAD in H/O patients. Hypothetical case scenarios were provided to assess variables influencing treatment choices (WBC, SCr, recent cancer treatment, stool volume) The questionnaire was sent to H/O and infectious diseases (ID) specialty pharmacists through professional organization email lists.

Results: The survey was sent to 2923 pharmacists. At interim analysis, 108 pharmacists (56% ID and 39% H/O) completed the survey. A majority (68%) practice at academic medical centers.  For uncomplicated first episode of CDAD in solid tumor patients, 72% chose oral metronidazole (M) and 28% chose oral vancomycin (V). These were equally prescribed for uncomplicated recurrence. For initial episode CDAD in neutropenic post-hematopoietic stem cell transplant (HSCT) patients, 60% chose oral V, but oral M (20%), oral V plus IV M (15%) and fidaxomicin (F; 5%) were also selected.  Increased SCr in HSCT patients altered treatment choices to 71% oral V, 11% F and only 9% oral M.  Recurrences in hematologic cancer patients were treated with oral V (74%), F (29%), and oral M (2%).  For persistent CDAD (continued symptoms 5 days after beginning treatment), oral V was the predominant agent (69%) followed by F (29%).

Conclusion: Choices for CDAD were diverse and not always consistent with the IDSA/SHEA guidelines. Differences in treatment choices were influenced by tumor and chemotherapy type, SCr, WBC and severity of CDAD symptoms.  CDAD therapy guidelines should be developed specifically for H/O patient populations.

Laura Gleason, PharmD1,2, Susanne Liewer, PharmD, BCOP1,2, Kiri Rolek, PharmD, BCPS1,2, Donald Klepser, PhD, MBA2 and Alison G. Freifeld, MD3, (1)Pharmacy, Nebraska Medicine, Omaha, NE, (2)University of Nebraska Medical Center College of Pharmacy, Omaha, NE, (3)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE


L. Gleason, None

S. Liewer, None

K. Rolek, None

D. Klepser, None

A. G. Freifeld, Merck: Data Safety Monitoring Board , Consulting fee
Astellas: Data Safety Monitoring Board , Consulting fee

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.