1253. Discordance of SHEA/IDSA Clostridium difficile Disease Severity Scale in Solid Organ Transplant Patients
Session: Poster Abstract Session: C. difficile: From the Bench to Bedside
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • 2017 IDWEEK SOT CDI Poster FINAL.pdf (241.6 kB)
  • Background: Solid organ transplant (SOT) patients are at high risk for Clostridium difficile infections (CDI) due to chronic immunosuppression and a propensity to receive antimicrobials. Management of CDI in SOT patients poses unique challenges as this population has disease-altered clinical and laboratory parameters. The objective of this study was to assess concordance between various CDI severity scales and the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) guidelines.

    Methods: This retrospective study included all SOT recipients with a first CDI episode following transplant and time-matched (2:1) to non-SOT patients experiencing first CDI episodes between 2008 and 2016. The primary endpoint was concordance rates of CDI episodes considered mild-moderate or severe/severe-complicated in published CDI scales compared to the SHEA/IDSA guidelines. We also sought to compare the distribution of CDI severity across all scales between SOT and non-SOT patients.

    Results: Overall, 32 SOT patients and 64 non-SOT patients were included. The SOT group had significantly higher leukopenia rates at CDI diagnosis; however, the magnitude of serum creatinine change did not differ between groups. According to the SHEA/IDSA scale, CDI episodes in SOT recipients were categorized as mild-moderate and severe/severe-complicated in 23 (72%) and 9 (28%) patients, respectively. Overall concordance rates among SHEA/IDSA guidelines and other scales ranged from 28% to 72%.  Concordance rates were highest for mild-moderate CDI with Belmares and for severe/severe-complicated CDI with ESCMID (Table 1).  No scale evenly categorized SOT and non-SOT patients across all severities (Figure 1).

    Conclusion: Severity scales with heavy emphasis on white blood cell counts may not adequately categorize SOT patients.  Immunocompromised status may need to be considered on its own when categorizing CDI severity and prescribing therapy.

    Table 1

    Number (%) of Severity Classification-Concordant CDI Episodes,

     in Comparison to SHEA/IDSA Guidelines

    Overall

    n=32

    Mild/Moderate

    n=23

    Severe or Severe-Complicated

    n=9

    AST

    23 (71.9)

    18 (78.3)

    5 (55.6)

    ESCMID

    9 (28.1)

    0

    9 (100)

    Zar

    20 (62.5)

    13 (56.5)

    7 (77.8)

    Belmares

    22 (68.8)

    22 (95.7)

    0

    Figure 1

    Tiffany Lee, PharmD1, Christopher McCoy, PharmD, BCPS-AQ ID1, Carolyn D. Alonso, M.D.2, Graham M. Snyder, MD, SM2, Christin Rogers, PharmD, BCPS, FFCP1, Katelyn Richards, PharmD, BCPS1, Elizabeth B. Hirsch, PharmD, BCPS1,3 and Monica V. Mahoney, PharmD, BCPS-AQ ID1, (1)Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, (2)Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, (3)Northeastern University, Boston, MA

    Disclosures:

    T. Lee, None

    C. McCoy, None

    C. D. Alonso, Merck: Grant Investigator and Scientific Advisor , Research grant
    Sanofi Pasteur: Investigator and Scientific Advisor , Research support
    GSK: Investigator , Research support

    G. M. Snyder, None

    C. Rogers, None

    K. Richards, None

    E. B. Hirsch, Merck: Grant Investigator , Grant recipient
    The Medicines Company: Speaker's Bureau , Speaker honorarium

    M. V. Mahoney, 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.