1275. Clostridium Difficile Infection in Hematopoietic Stem Cell Transplant Patients: A Single-Center experience.
Session: Poster Abstract Session: HAI: C. difficile Epidemiology, Impact, and Testing
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • Majeed Poster_44x84 Working File_v2 (1).pdf (695.5 kB)
  • Background: C. difficile infection ( CDI) is the most common cause of nosocomial infections in U.S. and leading cause of gastroenteritis associated death. Incidence of CDI in hematopoietic stem cell transplant (HSCT) patients has been reported between 5.7% to 24.7% during first year after HSCT. Literature review reveals many risk factors i.e. allogenic-HSCT, extremes of age, myeloablative conditioning, prior vancomycin resistance (VRE) colonization, pre-transplant C. difficile colonization, severe mucositis, graft versus host disease (GVHD), duration and type of antibiotics used, immunosuppression, proton pump inhibitor use and NAP1 C. difficile strain.

    Methods: To study incidence and different variables for CDI, we performed a retrospective review of medical records of adult patients who underwent HSCT between 2013 and 2016 at our center. REDCap database was used to record key variables related to each patient's HSCT and CDI, keeping in mind HIPPA guidelines. Categorical data were summed up as percentages and counts and numeric data as means, medians, standard deviations and ranges.

    Results: A total of 181 HSCT recipients were included. Incidence of CDI was 10% (18 Pts). Cohort’s most common underlying malignancy was multiple myeloma (35.4%). 70% had autologous HSCT and 30% had allogenic HSCT. Among allogenic transplants, 53% had matched unrelated donor. Peripheral blood was the most common stem cell source (93%). Most common myeloablative conditioning regimen was melphalan (70%). 27% patients were on PPIs. 4% had PEG/NG tube placed and 12% were on TPN. 10% had diabetes mellitus. 5 patients had previous episodes of CDI. 69% developed mucositis. 5% patients developed acute GVHD. 6% had VRE colonization while 66% had no documentation for VRE. Out of positive CDI cases, 17% were NAP1 positive. No episode of ileus or mega colon was documented. Most common treatment regimen were metronidazole 500 mg per orally every 8 hourly (65%) and vancomycin 125 mg per orally four times a day (58.8%).

    Conclusion: This single-center study demonstrates that CDI has 10% incidence in patients undergoing HSCT. Risk factors include neutropenia, high dose chemotherapy, mucosal damage and provision of broad spectrum antibiotic prophylaxis. Data on CDI prophylaxis in these patients is emerging and randomized prospective trials are needed.

    Aneela Majeed, MD1, Marti Larriva, PharmD2, Ahmad Iftikhar, MD3, Adeela Mushtaq, MD4, Nida Hassan, Undergraduate Student3, Auon A Hamadani, MD3, Nageena Khalid, Graduate student3, Melissa Lim, Graduate Student5, Tirdad Zangeneh, DO6 and Faiz Anwer, MD7, (1)Infectious Diseases Fellowship Program University of Arizona College of Medicine - Tucson, Tucson, AZ, (2)College of Pharmacy, Tucson, AZ, (3)University of Arizona, Tucson, AZ, (4)University of Arizona, Tuscon, AZ, (5)University of Arizona, tucson, AZ, (6)Department of Medicine, Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ, (7)Department of Medicine, Division of Hematology, Oncology, Blood and marrow transplantation, University of Arizona, Tucson, AZ

    Disclosures:

    A. Majeed, None

    M. Larriva, None

    A. Iftikhar, None

    A. Mushtaq, None

    N. Hassan, None

    A. A. Hamadani, None

    N. Khalid, None

    M. Lim, None

    T. Zangeneh, None

    F. Anwer, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.