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711. High Prevalence of Positive Cell Cytotoxicity Neutralization Assay in Symptomatic and Asymptomatic Pediatric Oncologic Patients

BACKGROUND: Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea in the United States. This burden is more prevalent and severe in the oncologic population and is associated with greater morbidity and mortality. Diagnostic modalities are limited, and misdiagnosis is...

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Autores principales: Zhang, David, Oram, Ronda, Landry, Meghan, Kumar, Madan, Cherny, Katie, Hillerbrand, Addison, Kociolek, Larry K, Davila, Nathalia, Galvan, Mariel, Knopoff, Karyssa, Ansari, Rasheed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678377/
http://dx.doi.org/10.1093/ofid/ofad500.773
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author Zhang, David
Oram, Ronda
Landry, Meghan
Kumar, Madan
Cherny, Katie
Hillerbrand, Addison
Kociolek, Larry K
Davila, Nathalia
Galvan, Mariel
Knopoff, Karyssa
Ansari, Rasheed
author_facet Zhang, David
Oram, Ronda
Landry, Meghan
Kumar, Madan
Cherny, Katie
Hillerbrand, Addison
Kociolek, Larry K
Davila, Nathalia
Galvan, Mariel
Knopoff, Karyssa
Ansari, Rasheed
author_sort Zhang, David
collection PubMed
description BACKGROUND: Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea in the United States. This burden is more prevalent and severe in the oncologic population and is associated with greater morbidity and mortality. Diagnostic modalities are limited, and misdiagnosis is high with resultant mismanaged care – inappropriate antibiotics, and potentially missed opportunities for appropriate targeted care towards graft-versus-host disease or other etiologies. To date, no large-scale evaluations have been performed to characterize the incidence of true disease in this population or to help delineate predictive markers for true infections (cell cytotoxicity neutralization assay (CCNA) positivity). METHODS: This is a multi-center, prospective stool banking study from January 2020 to date enrolling pediatric patients with an oncologic diagnosis admitted at Advocate Children’s Hospital and Comer Children’s Hospital. Stool was collected weekly along with relevant clinical histories and symptomology. Isolates of C. difficile were cultured and CCNA performed. Stool was also collected during episodes of PCR diagnosed CDI. RESULTS: 65 unique subjects were enrolled over 183 admissions. 11 samples from 10 patients were thought to represent CDI with PCR positivity noted. Five of these specimens were confirmed as CCNA positive while the remainder did not have active toxin presence. Bristol type 4 stools or > 3 stools in 24 hours were significant factors for modeling CCNA positivity, but not for modeling PCR positivity. Notably 26 stool specimens were CCNA positive, and 21 did not have PCR tests done. Among all CCNA positive specimens, no significant difference was noted in symptomatology or antibiotic use. [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: Differentiating true CDI can be challenging. However, even in patients with high risk of alternative GI pathology, the frequency of stooling and stool characteristics can be used. Although considered the gold standard for assessment of disease, CCNA positivity in this population was noted in patients who were not evaluated for disease by their primary providers. Underdiagnosis is possible, but potentially less likely given the absence of clinically significant differentiation in symptoms. Host factors predisposing to disease are likely present. DISCLOSURES: Larry K. Kociolek, MD, MSCI, Merck: Grant/Research Support
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spelling pubmed-106783772023-11-27 711. High Prevalence of Positive Cell Cytotoxicity Neutralization Assay in Symptomatic and Asymptomatic Pediatric Oncologic Patients Zhang, David Oram, Ronda Landry, Meghan Kumar, Madan Cherny, Katie Hillerbrand, Addison Kociolek, Larry K Davila, Nathalia Galvan, Mariel Knopoff, Karyssa Ansari, Rasheed Open Forum Infect Dis Abstract BACKGROUND: Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea in the United States. This burden is more prevalent and severe in the oncologic population and is associated with greater morbidity and mortality. Diagnostic modalities are limited, and misdiagnosis is high with resultant mismanaged care – inappropriate antibiotics, and potentially missed opportunities for appropriate targeted care towards graft-versus-host disease or other etiologies. To date, no large-scale evaluations have been performed to characterize the incidence of true disease in this population or to help delineate predictive markers for true infections (cell cytotoxicity neutralization assay (CCNA) positivity). METHODS: This is a multi-center, prospective stool banking study from January 2020 to date enrolling pediatric patients with an oncologic diagnosis admitted at Advocate Children’s Hospital and Comer Children’s Hospital. Stool was collected weekly along with relevant clinical histories and symptomology. Isolates of C. difficile were cultured and CCNA performed. Stool was also collected during episodes of PCR diagnosed CDI. RESULTS: 65 unique subjects were enrolled over 183 admissions. 11 samples from 10 patients were thought to represent CDI with PCR positivity noted. Five of these specimens were confirmed as CCNA positive while the remainder did not have active toxin presence. Bristol type 4 stools or > 3 stools in 24 hours were significant factors for modeling CCNA positivity, but not for modeling PCR positivity. Notably 26 stool specimens were CCNA positive, and 21 did not have PCR tests done. Among all CCNA positive specimens, no significant difference was noted in symptomatology or antibiotic use. [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: Differentiating true CDI can be challenging. However, even in patients with high risk of alternative GI pathology, the frequency of stooling and stool characteristics can be used. Although considered the gold standard for assessment of disease, CCNA positivity in this population was noted in patients who were not evaluated for disease by their primary providers. Underdiagnosis is possible, but potentially less likely given the absence of clinically significant differentiation in symptoms. Host factors predisposing to disease are likely present. DISCLOSURES: Larry K. Kociolek, MD, MSCI, Merck: Grant/Research Support Oxford University Press 2023-11-27 /pmc/articles/PMC10678377/ http://dx.doi.org/10.1093/ofid/ofad500.773 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Zhang, David
Oram, Ronda
Landry, Meghan
Kumar, Madan
Cherny, Katie
Hillerbrand, Addison
Kociolek, Larry K
Davila, Nathalia
Galvan, Mariel
Knopoff, Karyssa
Ansari, Rasheed
711. High Prevalence of Positive Cell Cytotoxicity Neutralization Assay in Symptomatic and Asymptomatic Pediatric Oncologic Patients
title 711. High Prevalence of Positive Cell Cytotoxicity Neutralization Assay in Symptomatic and Asymptomatic Pediatric Oncologic Patients
title_full 711. High Prevalence of Positive Cell Cytotoxicity Neutralization Assay in Symptomatic and Asymptomatic Pediatric Oncologic Patients
title_fullStr 711. High Prevalence of Positive Cell Cytotoxicity Neutralization Assay in Symptomatic and Asymptomatic Pediatric Oncologic Patients
title_full_unstemmed 711. High Prevalence of Positive Cell Cytotoxicity Neutralization Assay in Symptomatic and Asymptomatic Pediatric Oncologic Patients
title_short 711. High Prevalence of Positive Cell Cytotoxicity Neutralization Assay in Symptomatic and Asymptomatic Pediatric Oncologic Patients
title_sort 711. high prevalence of positive cell cytotoxicity neutralization assay in symptomatic and asymptomatic pediatric oncologic patients
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678377/
http://dx.doi.org/10.1093/ofid/ofad500.773
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