2672. Clostridioides difficile Infection Among Bone Marrow Transplant Recipients: Findings From a Single Institution

Abstract

Background Clostridioides difficile infection (CDI) is increasingly common among hematopoietic stem cell transplantation (HSCT) recipients and efforts to define CDI risk have shown variable results. The primary objective of this study was to further characterize CDI incidence and risk factors in HSCT recipients.MethodsAll allogeneic and autologous HSCT recipients at Loyola University Chicago between January 2011 and May 2017 were retrospectively reviewed for development of CDI within 6 months prior to 2 years following HSCT. Collected data include comorbid conditions, statin or proton pump inhibitor (PPI), and antimicrobial use. HSCT baseline information was also obtained and include underlying malignancy, prior chemotherapy, graft type, conditioning regimen consisting of total body irradiation (TBI) use, and donor source (matched related or unrelated and umbilical cord blood). Among those with diagnosed CDI, data pertaining to CDI severity, treatment, and recurrence was collected. Logistic regression analyses were performed to estimate odds ratios for factors associated with development of CDI.ResultsSix hundred eighty-nine patients met our inclusion criteria. Of these, 367 (53%) underwent autologous HSCT and 322 (47%) allogeneic HSCT. Among all patients, 132 (19.1%) had CDI of which 26 (19.7%) had recurrence within 60 days. In univariable analysis, any type of leukemia was associated with increased odds of CDI compared with lymphoma (OR = 2.44, 95% CI: 1.49- 4.00, P < 0.01) as was allogeneic HSCT compared with autologous (OR = 2.51, 95% CI: 1.63–3.88, P < 0.01 for matched and OR = 3.96, 95% CI: 2.31–6.79, P < 0.01 for cord blood) and use of TBI (OR = 1.63, 95% CI: 1.10 – 2.40, P < 0.05). Exposure to any cephalosporin or intravenous vancomycin within 100 days of HSCT was associated with CDI (OR = 1.55, 95% CI: 1.03–2.32, P < 0.05 and OR = 1.75, 95% CI: 1.19–2.58, P < 0.01 respectively). No significant differences in the odds of developing CDI were identified by patient comorbidities, statin or PPI use.ConclusionIn our population there was a 19% incidence of CDI. Underlying leukemia, TBI exposure, and allogeneic HSCT appear to be risk factors for CDI and further research is needed to evaluate whether exposure to cephalosporin or vancomycin may be modifiable risk factors. Disclosures All authors: No reported disclosures.