Cargando…
Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results
BACKGROUND: C. difficile infection is common in patients with hematologic malignancy. There is increasing recognition that molecular (polymerase chain reaction, PCR) based testing lacks specificity for infection, while detecting patients with colonization. The objective of our study was to evaluate...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631230/ http://dx.doi.org/10.1093/ofid/ofx163.987 |
_version_ | 1783269402875002880 |
---|---|
author | Ziegler, Matthew Landsburg, Daniel Pegues, David Alby, Kevin Gilmar, Cheryl Bink, Kristen Gorman, Theresa Moore, Amy Han, Jennifer |
author_facet | Ziegler, Matthew Landsburg, Daniel Pegues, David Alby, Kevin Gilmar, Cheryl Bink, Kristen Gorman, Theresa Moore, Amy Han, Jennifer |
author_sort | Ziegler, Matthew |
collection | PubMed |
description | BACKGROUND: C. difficile infection is common in patients with hematologic malignancy. There is increasing recognition that molecular (polymerase chain reaction, PCR) based testing lacks specificity for infection, while detecting patients with colonization. The objective of our study was to evaluate characteristics of patients with toxin enzyme immunoassay (EIA) vs. PCR positive C. difficile test results. METHODS: A retrospective review of inpatients at a tertiary care academic center with hematologic malignancy and a positive C. difficile test from 1/2015 to 1/2016 was performed. Data on demographics, comorbidities, clinical features, and outcomes were collected using medical record review. Characteristics were compared between patients with EIA vs. PCR positive test results using chi-squared or Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. RESULTS: A total of 130 patients were included: 51% and 49% had a PCR positive and EIA positive result, respectively. Diagnoses included AML (42%), multiple myeloma (22%), and Non-Hodgkin’s lymphoma (13%). Antibiotic exposure was similar, with a median of 4 days of anti-pseudomonal antibiotics received in the prior 30 days. There was no difference in history of a positive C. difficile test in the prior year (12% in the EIA group, 10% in the PCR group, P = 0.71). Patients with EIA positive results were more likely to have a WBC ≥15/mm(3) (18% vs. 6%, P = 0.02). However, there were no differences in presence of fever, stool frequency, or imaging evidence of colitis at the time of testing. Medications in the prior 72 hours were similar, including the use of proton pump inhibitors of ~40% and of laxatives of 28%. Clinical outcomes were also similar between patients with EIA vs. PCR positive tests: all-cause death (22% vs. 20%), recurrent CDI (9% vs. 13%), colectomy (1% vs. 4%), and megacolon (0% vs. 3%). Most patients received treatment with oral vancomycin for a median duration of 14 days. CONCLUSION: In patients with hematologic malignancy, those with EIA vs. PCR positive C. difficile test results were clinically similar. These findings suggest that algorithms for testing and treatment of C. difficile in hematologic malignancy patients will need to be specifically targeted towards this immunocompromised population. DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-5631230 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-56312302017-11-07 Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results Ziegler, Matthew Landsburg, Daniel Pegues, David Alby, Kevin Gilmar, Cheryl Bink, Kristen Gorman, Theresa Moore, Amy Han, Jennifer Open Forum Infect Dis Abstracts BACKGROUND: C. difficile infection is common in patients with hematologic malignancy. There is increasing recognition that molecular (polymerase chain reaction, PCR) based testing lacks specificity for infection, while detecting patients with colonization. The objective of our study was to evaluate characteristics of patients with toxin enzyme immunoassay (EIA) vs. PCR positive C. difficile test results. METHODS: A retrospective review of inpatients at a tertiary care academic center with hematologic malignancy and a positive C. difficile test from 1/2015 to 1/2016 was performed. Data on demographics, comorbidities, clinical features, and outcomes were collected using medical record review. Characteristics were compared between patients with EIA vs. PCR positive test results using chi-squared or Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. RESULTS: A total of 130 patients were included: 51% and 49% had a PCR positive and EIA positive result, respectively. Diagnoses included AML (42%), multiple myeloma (22%), and Non-Hodgkin’s lymphoma (13%). Antibiotic exposure was similar, with a median of 4 days of anti-pseudomonal antibiotics received in the prior 30 days. There was no difference in history of a positive C. difficile test in the prior year (12% in the EIA group, 10% in the PCR group, P = 0.71). Patients with EIA positive results were more likely to have a WBC ≥15/mm(3) (18% vs. 6%, P = 0.02). However, there were no differences in presence of fever, stool frequency, or imaging evidence of colitis at the time of testing. Medications in the prior 72 hours were similar, including the use of proton pump inhibitors of ~40% and of laxatives of 28%. Clinical outcomes were also similar between patients with EIA vs. PCR positive tests: all-cause death (22% vs. 20%), recurrent CDI (9% vs. 13%), colectomy (1% vs. 4%), and megacolon (0% vs. 3%). Most patients received treatment with oral vancomycin for a median duration of 14 days. CONCLUSION: In patients with hematologic malignancy, those with EIA vs. PCR positive C. difficile test results were clinically similar. These findings suggest that algorithms for testing and treatment of C. difficile in hematologic malignancy patients will need to be specifically targeted towards this immunocompromised population. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2017-10-04 /pmc/articles/PMC5631230/ http://dx.doi.org/10.1093/ofid/ofx163.987 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Ziegler, Matthew Landsburg, Daniel Pegues, David Alby, Kevin Gilmar, Cheryl Bink, Kristen Gorman, Theresa Moore, Amy Han, Jennifer Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results |
title | Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results |
title_full | Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results |
title_fullStr | Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results |
title_full_unstemmed | Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results |
title_short | Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results |
title_sort | clinical characteristics and outcomes of hematologic malignancy patients with clostridium difficile toxin eia vs. pcr positive test results |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631230/ http://dx.doi.org/10.1093/ofid/ofx163.987 |
work_keys_str_mv | AT zieglermatthew clinicalcharacteristicsandoutcomesofhematologicmalignancypatientswithclostridiumdifficiletoxineiavspcrpositivetestresults AT landsburgdaniel clinicalcharacteristicsandoutcomesofhematologicmalignancypatientswithclostridiumdifficiletoxineiavspcrpositivetestresults AT peguesdavid clinicalcharacteristicsandoutcomesofhematologicmalignancypatientswithclostridiumdifficiletoxineiavspcrpositivetestresults AT albykevin clinicalcharacteristicsandoutcomesofhematologicmalignancypatientswithclostridiumdifficiletoxineiavspcrpositivetestresults AT gilmarcheryl clinicalcharacteristicsandoutcomesofhematologicmalignancypatientswithclostridiumdifficiletoxineiavspcrpositivetestresults AT binkkristen clinicalcharacteristicsandoutcomesofhematologicmalignancypatientswithclostridiumdifficiletoxineiavspcrpositivetestresults AT gormantheresa clinicalcharacteristicsandoutcomesofhematologicmalignancypatientswithclostridiumdifficiletoxineiavspcrpositivetestresults AT mooreamy clinicalcharacteristicsandoutcomesofhematologicmalignancypatientswithclostridiumdifficiletoxineiavspcrpositivetestresults AT hanjennifer clinicalcharacteristicsandoutcomesofhematologicmalignancypatientswithclostridiumdifficiletoxineiavspcrpositivetestresults |