Risk of Clostridium difficile Infection in Hematology-Oncology Patients Colonized With Toxigenic C. difficile

Cannon, Cara M.; Musuuza, Jackson; Barker, Anna; Duster, Megan; Juckett, Mark; Pop-Vicas, Aurora; Safdar, Nasia

doi:10.1017/ice.2017.48

Cited by 29 publications

(17 citation statements)

References 10 publications

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“…Similar to a recent adult study, our data show that pediatric patients who are asymptomatically colonized at admission are at the highest risk of developing CDI during that admission. We also show that this subsequent CDI is almost exclusively related to the patient's own colonized strain, and not related to other patients’ strains.…”

Section: Discussionsupporting

confidence: 90%

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Pediatric oncology and stem cell transplant patients with healthcare‐associated Clostridium difficile infection were already colonized on admission

Al‐Rawahi

Alnajjar

McDonald

et al. 2019

Pediatric Blood & Cancer

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Clostridium difficile is the leading cause of healthcare‐associated infections worldwide. The diagnosis of C. difficile infection (CDI) in pediatric oncology patients is complex as diarrhea is common, and there is a high rate of colonization in infants and young children. This study was conducted to assess the accuracy of the surveillance definitions of healthcare‐associated CDI (HA‐CDI) and to determine the prevalence of toxigenic C. difficile colonization among pediatric oncology and stem cell transplant patients. Methods A prospective cohort study was conducted over a three‐year period in an inpatient pediatric oncology and stem cell transplant setting. Baseline stool samples were collected within three days of admission and were genotypically compared with clinically indicated samples submitted after three days of admission. Results A total of 175 patients were recruited with a total of 536 admissions. The adjusted prevalence of baseline toxigenic C. difficile colonization among admissions was 32.8%. Seventy‐eight percent of positive admissions did not have history of CDI. Colonization with a toxigenic strain on admission was predictive of CDI (OR = 28.6; 95% CI, 6.58–124.39; P < 0.001). Nearly all clinical isolates (8/9) shared identical pulsed‐field gel electrophoresis patterns with baseline isolates or were closely related (1/9). Only one of the 11 cases that were considered HA‐CDI was potentially nosocomially acquired. Conclusion The prevalence of colonization with toxigenic C. difficile in our cohort is high. Unfortunately, the current CDI surveillance definitions overestimate the incidence of HA‐CDI in pediatric oncology and stem cell transplantation settings.

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Section: Discussionsupporting

confidence: 90%

“…Similar to a recent adult study, 22 band, which is still considered closely related. 23 This is the fundamental finding of this study, and has two major implications.…”

Section: Discussionsupporting

confidence: 84%

Pediatric oncology and stem cell transplant patients with healthcare‐associated Clostridium difficile infection were already colonized on admission

Al‐Rawahi

Alnajjar

McDonald

et al. 2019

Pediatric Blood & Cancer

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“…The median age for C difficile positivity in the PTP and NTP was 6.1 and 5.8 years, respectively, with the PTP having a lower percentage of positive tests in patients <2 years old. Beyond infancy, higher rates of colonization and prolonged shedding in stool have been demonstrated in similar populations and are also likely contributing factors 18‐23 …”

Section: Discussionmentioning

confidence: 95%

Multi‐organism gastrointestinal polymerase chain reaction positivity among pediatric transplant vs non‐transplant populations: A single‐center experience

Stone

Savage

Hudspeth

et al. 2020

Pediatric Transplantation

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Background Diarrhea is a common problem in the pediatric post‐solid organ transplant and post‐hematopoietic stem cell transplant populations. Infectious etiology incidences are poorly defined, and the possibility of multi‐organism positivity is often uninvestigated. The aim of this study is to utilize stool multiplex GIP assays to compare the PTP and NTP regarding the incidence and profiles of single‐organism and multi‐organism infectious diarrhea. Methods A single‐center retrospective review was conducted, investigating stool multiplex GIP panel results over a more than 3‐year period, for pediatric patients. Assays test for 23 viral, bacterial, and protozoal organisms. Results Positive assays in the PTP and NTP were 70/101 (69.3%) and 962/1716 (56.1%), respectively (P = .009). Thirty‐two percent (32/101) of assays within the PTP were multi‐organism positive, significantly more than 14.8% (254/1716) in the NTP (P < .00001). There was no significant difference in the incidence of single‐organism positives, 37.6% (38/101) in PTP and 41.3% (708/1716) in the NTP. The PTP demonstrated a statistically significantly higher incidence of the following organisms within multi‐agent positive GIPs (P < .05 for each): Clostridioides difficile, Cryptosporidium, EPEC, norovirus, and sapovirus. Conclusions The pediatric PTP demonstrates higher incidence of positive GIPs, higher rate of multi‐organism positivity, and unique infectious organism incidence profiles. These data can provide a framework for understanding organism‐specific pathogenicity factors, assessing the clinical impact of enteric co‐infection, and understanding the utility of this testing modality in this unique population.

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“…As discussed above, a fiber-deficient diet has been shown to hinder clearance of C. difficile after challenge (15) . This is particularly relevant in a clinical context as recent studies of both pediatric and adult oncology patients have shown asymptomatic colonization rates with C. difficile of ∼30% and ∼10%, respectively (3, 31) . Further, in pediatric patients it was demonstrated that the vast majority of “hospital-acquired” CDI may be caused by a strain of C. difficile that is present at admission rather than a strain acquired during the patient stay (3) .…”

Section: Discussionmentioning

confidence: 99%

Dietary fat promotes antibiotic-induced Clostridioides difficile mortality in mice

Hazleton

Martin

Arnolds

et al. 2019

Preprint

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One Sentence Summary: High dietary fat promoted mortality in a mouse model of antibiotic-17 induced C. difficile infection and low dietary fiber caused higher microbiome disturbance upon 18 broad-spectum antibiotic exposure, suggesting that diets low in fat and high in fiber may protect 19 against C. difficile pathogenesis.Abstract: Clostridoides difficile infection (CDI) is a leading cause of hospital-acquired diarrhea 22 and there has been a steady increase in the number of new infections, emphasizing the 23 importance of novel prevention strategies. Use of broad-spectrum antibiotics and disruption of 24 the intestinal microbiome is one of the most important risk factors of CDI. We used a murine 25 model of antibiotic-induced CDI to investigate the relative contributions of high dietary fat and 26 low dietary fiber on disease pathogenesis. We found that high fat, but not low fiber resulted in 27 increased mortality from CDI (HR 4.95) and increased levels of C. difficile toxin production 28 compared to a regular low-fat/high-fiber mouse diet even though we did not observe a significant 29 change in C. difficile carriage. The high-fat diet also increased levels of primary bile acids 30 known to be germination factors for C. difficile spores. Mice fed low-fat/low-fiber diets did not 31 show increased CDI pathogenesis, but did have a larger antibiotic-induced gut microbiome 32 disturbance compared to mice fed a high-fiber diet, characterized by a greater decrease in alpha 33 diversity. This microbiome disturbance was associated with a loss of secondary bile acids and 34 short chain fatty acids, which are both microbial metabolic products previously shown to protect 35 against CDI. These data suggest that a low-fiber diet contributes to antibiotic-induced dysbiosis, 36 while a high-fat diet promotes CDI pathogenesis. These findings indicate that dietary 37 interventions that increase fiber and decrease fat may be an effective prevention strategy for 38 individuals at high risk of CDI. 39 40 41Clostridoides difficile infection (CDI) is an important cause of morbidity and mortality, 42 with 500,000 cases every year causing 30,000 deaths per year in the US alone (1). Alarmingly, 43 there has been a steady increase in the number of new infections in spite of prevention efforts in 44 hospitals that have focused largely on increased sanitation and antibiotic stewardship (2). These 45 prevention approaches treat CDI as a traditional communicable infection. However, recent data 46 suggests that CDI is often caused by the activation of strains that were already carried in the gut 47 prior to hospital admission and prior to the onset of symptoms rather than by acquisition of a 48 hospital-resident strain (3). Thus, determining strategies to reduce C. difficile carriage and 49 attenuate CDI severity is critical. 50A complex gut microbiome has been shown to be protective against CDI (4). Broad 51 spectrum antibiotic usage, such as clindamycin, beta-lactams, and fluoroquinolones (5, 6) 52 increase risk of CDI as d...

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Risk of Clostridium difficile Infection in Hematology-Oncology Patients Colonized With Toxigenic C. difficile

Cited by 29 publications

References 10 publications

Pediatric oncology and stem cell transplant patients with healthcare‐associated Clostridium difficile infection were already colonized on admission

Pediatric oncology and stem cell transplant patients with healthcare‐associated Clostridium difficile infection were already colonized on admission

Multi‐organism gastrointestinal polymerase chain reaction positivity among pediatric transplant vs non‐transplant populations: A single‐center experience

Dietary fat promotes antibiotic-induced Clostridioides difficile mortality in mice

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