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Risk factors & epidemiology of CDI in HSCT recipients recipients during the peritransplant period

Hematopoietic stem cell transplant (HSCT) recipients represent a high- risk group for developing Clostridium difficile infection (CDI). We aimed to identify specific risk factors for CDI in an HSCT patient population during the peritransplant period. We performed a case–control study within a cohort of HSCT patients who received a transplant from November 2010 to March 2013. Cases had a clinical presentation compatible with CDI and a positive stool sample Xpert® C. difficile test. Controls were CDI negative and matched on age, gender, and transplant type. Peritransplant period was defined as −30 days or time of stem cell mobilization maneuver to 30 days post transplant in autologous SCT or 90 days post transplant in allogeneic SCT. Of 781 HSCTs performed during the study period, 650 (83.2%) had a stool sample submitted for CD testing. Eight- six (13.2%) cases with CDI were identified. Most of the cases were diagnosed within a week after transplantation (median of 5 days). In adjusted analysis, prior hospitalization (odds ratio [OR]: 2.01, 95% confidence interval [CI] 1.2- 3.36), prior cephalosporin administration (OR 2.72, 95% CI: 1.54- 4.83), and prior chemotherapy (OR: 3.26, 95% CI: 1.92- 5.5) were significantly associated with CDI. Hospitalization, and prior antibiotic and chemotherapy use are risk factors that are not easily modifiable, which emphasizes the need to start investigating preventive or prophylactic strategies in this high- risk population.


Clostridium difficile is the most common cause of infectious healthcare-associated diarrhea. It was responsible for almost half a million infections and approximately 29,000 deaths in 2011 in the United States. Hematopoietic stem cell transplant (HSCT) patients can be particularly susceptible to C. difficile infection (CDI) owing to presence of multiple risk factors including prolonged hospitalization, multiple antibiotic regimens, and use of chemotherapeutic agents. The peritransplant period (30 days post-transplant) appears to be an especially high-risk time for acquisition of CDI.

In this study, we tried to identify patient characteristics associated with development of CDI during the peritransplant period among HSCT patients. Of the 781 HSCTs performed from 2010 to 2013 at Emory, 650 had summitted a stool sample for CDI testing. Of the 650 that submitted stool samples 86 (13.2%) cases were identified as having CDI. We confirmed that the first week after transplant is the highest for risk of developing CDI. We also found higher rates of CDI in the allogenic HSCT recipients compared to the autologous HSCT recipients. Our study also showed a higher 100-day mortality in transplant recipients that developed CDI than compared to transplant recipients that did not develop CDI.


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