1602. Clostridium difficile Infection as a Predictor of Acute Graft vs. Host Disease Among Allogenic Stem Cell Transplant Recipients

Abstract

Background Clostridium difficile infection (CDI) is a major cause of infectious diarrhea especially among allogenic stem cell transplant (SCT) recipients. The relationship between CDI and acute Graft vs. Host Disease (aGvHD) has been a topic of great interest for some time, as either of the two conditions may affect the other. We studied the temporal relation of CDI on aGvHD in the first 100 days posttransplant in a large cohort of allogeneic SCT recipients.MethodsWe conducted an analysis of retrospective data extracted from the medical records of adult patients (more than 18 years of age) who underwent their first allogenic SCT between January 1, 2010 and December 30, 2016 at the University of Kansas Health System. Patients were followed for CDI events between day −10 to day +100 of allogenic transplant. Diagnosis and staging of aGvHD were determined based on standardized aGvHD grading scale utilizing clinical and pathological information between day 0 and day +100. Analysis included descriptive statistics, multivariable logistic regression, and survival analysis with CDI as a time-dependent variable.ResultsA total of 656 allogenic SCT recipients were included in the analysis. Of the total sample, 419 (64%) developed aGvHD within the first 100 days. CDI was observed in 112 (17%) of all allogenic SCT recipients, 72 (64%) of CDI cases developed prior to the onset of aGvHD. Fidaxomicin was used in the treatment of 57 (50%), whereas, vancomycin was used in 53 (47%) of CDI cases. On unadjusted analysis, CDI was associated with aGvHD (P = 0.0036), high grade aGvHD (P = 0.0132), and GI aGvHD (P = 0.0003). On multivariate survival analysis, the following predictors were associated with aGvHD: CDI (adjusted Hazard Ratio (aHR) = 1.44, P = 0.0047), matched unrelated donor vs. matched related donor transplant type (aHR = 1.40, P = 0.0023), myeloablative vs. reduced intensity conditioning (aHR = 1.87, P < 0.0001). This was consistent with the stepwise logistic regression model.ConclusionAllogenic SCT recipients with CDI have a higher risk of aGvHD compared with those without CDI.Disclosures All authors: No reported disclosures.