Clostridium difficile Infection Incidence and Risk Factors within Pediatric and Adult Hospitalization Sites after Allogeneic Hematopoietic Cell Transplantation
Boyle, Nicole Marie
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BACKGROUND: Although Clostridium difficile infection (CDI) is the most common cause of nosocomial infectious diarrhea, the relationship between hematopoietic cell transplantation (HCT) and CDI is not well understood. Furthermore, although the experiences of adult and pediatric HCT recipients differ, studies of CDI in HCT have primarily focused on adults; the potential CDI risk imposed by many unique experiences in pediatric HCT warrants separate study. METHODS: To explore these questions, we retrospectively reviewed CDI incidence and risk factors 100-days post-transplant among allogeneic recipients of the Fred Hutchinson Cancer Research Center from 2008-2012. All analyses were conducted separately per hospital (pediatric or adult). Patients under 1-year of age and those with evidence of preexisting CDI were excluded. Cumulative incidence curves were estimated from subdistribution hazards, and potential CDI risk factors (age, year, graft type, myeloablative transplant, graft-versus-host disease [GVHD] prophylaxis, and acute GVHD severity) were analyzed using Cox proportional hazard models. RESULTS: CDI was diagnosed in 33/192 (17%) pediatric recipients at a median of 51 days (Interquartile Range [IQR]: 5, 72); and 107/990 (11%) adults at a median of 16 days (IQR: 5, 49). Overall, testing for CDI appeared less widespread among pediatric patients (47% tested at least once) than adults (76%). In risk factor analyses, year of transplant was associated with CDI among pediatric patients (p<.05). Among adults, univariate analyses found myeloablative transplant (Hazard Ratio [HR]: 1.81, p=.0047) associated with increased CDI risk and ages 60+ (HR: 0.61, p=.037) protective against CDI; these associations did not persist in multivariable models. DISCUSSION: Our novel examination of CDI risk among allogeneic HCT recipients shows that children and adults are at high risk of CDI during the first 100-days post-transplant. The possible increased risk found among pediatric recipients in our study supports the differentiation of children from adults in future studies of CDI after HCT.
- Epidemiology