1018. Treatment Outcomes of Clostridium difficile Infection in Neutropenic Adults
Session: Poster Abstract Session: Enteric Infection
Friday, October 9, 2015
Room: Poster Hall
Posters
  • C.diff in neutropenia IDWeek2015.pdf (148.5 kB)
  • Background:  Multiple factors including an elevated white blood cell count are recommended to be assessed in order to classify disease severity and guide antimicrobial selection in current guidelines for the treatment of Clostridium difficile infections (CDI). However, a paucity of data exists regarding the appropriate treatment and classification of CDI in the patient with neutropenia.

    Methods:  This retrospective case-control study was conducted at a large academic medical center from January 2012 through December 2014. Adult inpatients ≥18 years of age were enrolled if an initial episode of CDI was detected within 7 days of an absolute neutrophil count <500/mm3. Data collected included demographics, CDI and non-CDI antibiotic exposure, resolution of diarrhea, and CDI complications including colectomy, colonic perforation, ileus, toxic megacolon and CDI-attributed mortality. The primary objective was resolution of diarrhea at day 14. 

    Results:  We evaluated 88 patients with a median age of 56 years [IQR 42-63]. The median Charlson Comorbidity Index was 3 [2-8] and 39 (44.3%) patients underwent a stem cell transplant prior to the infection. Median duration of CDI antibiotics was 16 [14-20] days, with 14 [9-16] days of metronidazole and 0 [0-14] days of oral vancomycin.   Overall, 22 (25%) patients had diarrhea that persisted at day 14. Patients with persistent diarrhea received more oral vancomycin (median 8 [0-16] vs. 0 [0-14] days, p=0.022); however, no other significant differences between groups were observed.  CDI complications occurred in 9 (10.2%) patients, with 5 (5.7%) CDI-attributable deaths. Patients with a CDI complication received a longer duration of CDI targeted antibiotics (median 19 [9-22] vs. 16 [14-19] days, p<0.001) than those without a complication.

    Conclusion:  CDI requires aggressive treatment and removal of potentiating factors that may pose a risk for neutropenic patients. While many neutropenic patients experienced resolution of diarrhea while receiving CDI targeted antibiotic monotherapy, identification of specific risk factors may help in identifying those who may benefit from an escalation in treatment or combination therapy.

    Michael Kenes, PharmD, BCPS1, Pratish Patel, PharmD, BCPS1, Whitney Jones, PharmD, BCPS1, George Nelson, MD1, Joanna Stollings, PharmD, BCPS1, Matt Marshall, PharmD1 and David Aronoff, MD, FIDSA2, (1)Vanderbilt University Medical Center, Nashville, TN, (2)Vanderbilt University School of Medicine, Division of Infectious Diseases, Nashville, TN

    Disclosures:

    M. Kenes, None

    P. Patel, None

    W. Jones, None

    G. Nelson, None

    J. Stollings, None

    M. Marshall, None

    D. Aronoff, None

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