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• W2240810439 abstract "Background Clostridium difficile (CD) is the leading cause of nosocomial diarrhea. After acquisition of CD, some patients (pts) remain colonized whereas others develop symptomatic CD infection (CDI). Hematopoietic stem cell transplant (HSCT) recipients are at higher risk of CDI than the general population. Rates of colonization and risk factors for CD colonization in the HSCT population are unknown. The goals of this study were to determine the rates and predictors of colonization with CD in HSCT pts at our institution. Methods We conducted a 16-month prospective study starting in December 2010 in the HSCT unit at the Karmanos Cancer Center. Pts who signed informed consent had stool samples collected within 72 hours of admission and weekly thereafter until discharge. Pts were followed up for 90 days after enrollment. Stool samples were cultured for CD and culture positive samples were tested by PCR for confirmation of toxigenic CD. Demographic information, risk factors and outcomes were examined. Results 154 patients who underwent allogeneic HSCT were enrolled in the study. Mean age for both CD colonized and non-colonized pts was 51 ±12.8 years, 59% were males. Overall, 47/154 (30%) pts were colonized with CD at admission; 23/154 (15%) with toxigenic CD. 8/23 (34%) pts colonized with toxigenic CD developed symptomatic CDI. Of the pts colonized with non-toxigenic CD, 7/24 (29%) acquired CD during the hospital stay. The median time to acquisition was week 2 of hospitalization. On bivariate analysis, underlying comorbid conditions and traditional risk factors for CDI like prior hospitalization, length-of-stay, antibiotic use, nasogastric tube and gastrointestinal tract procedures were found to be equally prevalent in both colonized and non-colonized population. The outcome in terms of graft versus host disease (GVHD) was also similar in both groups. The use of proton pump inhibitors was more prevalent in non-colonizers (56%) vs. colonizers (43%). However, it was not statistically significant (p=0.16). Similarly, lymphopenia seemed common amongst colonizers vs. non-colonizers (67% vs. 58%) but was not statistically significant (p=0.2). Conclusion Colonization with toxigenic CD is high in our HSCT recipients at hospital admission. Symptomatic CDI occurs in a third of pts colonized with toxigenic CD. Unlike in the general population, traditional risk factors for CD colonization are not predictive of colonization in our allogeneic HSCT pts. Novel approaches such as active surveillance to detect colonized patients to guide infection control measures and to direct “pre-emptive” therapy should be evaluated in this population. Disclosures: No relevant conflicts of interest to declare." @default.
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• W2240810439 date "2013-11-15" @default.
• W2240810439 modified "2023-09-26" @default.
• W2240810439 title "Prospective Evaluation Of Risk Factors For Clostridium Difficile Colonization Among Allogenic Hematopoietic Stem Cell Transplant Recipients, 2010-2012" @default.
• W2240810439 doi "https://doi.org/10.1182/blood.v122.21.4563.4563" @default.
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