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Transmission of Clostridium difficile During Hospitalization for Allogeneic Stem Cell Transplant

Published online by Cambridge University Press:  21 October 2015

Mini Kamboj ,
Anna Sheahan ,
Janet Sun ,
Ying Taur ,
Elizabeth Robilotti ,
Esther Babady ,
Genovefa Papanicolaou ,
Ann Jakubowski ,
Eric Pamer  and
Kent Sepkowitz
Mini Kamboj*
Affiliation:
Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
Anna Sheahan
Affiliation:
Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Janet Sun
Affiliation:
Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Ying Taur
Affiliation:
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
Elizabeth Robilotti
Affiliation:
Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
Esther Babady
Affiliation:
Department of Clinical Laboratories, Memorial Sloan Kettering Cancer Center, New York, New York
Genovefa Papanicolaou
Affiliation:
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
Ann Jakubowski
Affiliation:
Department of Medicine, Weill Cornell Medical College, New York, New York Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Eric Pamer
Affiliation:
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
Kent Sepkowitz
Affiliation:
Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
*
Address correspondence to Mini Kamboj, MD, 1275 York Ave, Box 9, New York, NY 10065 (Kambojm@mskcc.org).
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Abstract

OBJECTIVE

To determine the role of unit-based transmission that accounts for cases of early Clostridium difficile infection (CDI) during hospitalization for allogeneic stem cell transplant.

SETTING

Stem cell transplant unit at a tertiary care cancer center.

METHODS

Serially collected stool from patients admitted for transplant was screened for toxigenic C. difficile through the hospital stay and genotyping was performed by multilocus sequence typing. In addition, isolates retrieved from cases of CDI that occurred in other patients hospitalized on the same unit were similarly characterized. Transmission links were established by time-space clustering of cases and carriers of shared toxigenic C. difficile strains.

RESULTS

During the 27-month period, 1,099 samples from 264 patients were screened, 69 of which had evidence of toxigenic C. difficile; 52 patients developed CDI and 17 were nonsymptomatic carriers. For the 52 cases, 41 had evidence of toxigenic C. difficile on the first study sample obtained within a week of admission, among which 22 were positive within the first 48 hours. A total of 24 sequence types were isolated from this group; 1 patient had infection with the NAP1 strain. A total of 11 patients had microbiologic evidence of acquisition; donor source could be established in half of these cases.

CONCLUSIONS

Most cases of CDI after stem cell transplant represent delayed onset disease in nonsymptomatic carriers. Transmission on stem cell transplant unit was confirmed in 19% of early CDI cases in our cohort with a probable donor source established in half of the cases.

Infect. Control Hosp. Epidemiol. 2015;37(1):8–15

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 1 , January 2016 , pp. 8 - 15
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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