2383. Epidemiological and Clinical Features of Clostridioides difficile Infections in Pediatric Oncology and Transplant Patients

BACKGROUND: Clostridioides difficile infection (CDI) is the most common cause of healthcare-associated diarrhea-causing significant morbidity and mortality in adults. The epidemiology and clinical course of CDI in children, especially with cancer are poorly defined. We aim to describe the clinical, epidemiological features and outcomes of CDI, and identify risk factors for recurrence in a pediatric oncology center METHODS: This is a retrospective cohort study of CDI in pediatric oncology and hematopoietic stem cell transplant (HSCT) patients in 2016 and 2017. CDI cases were identified by electronic medical record search for positive C. difficile PCR tests. CDI episodes were classified as incident, duplicate or recurrent and community-onset (CO), hospital-onset (HO), or community-onset healthcare facility associated (COHCFA) using National Healthcare Safety Network surveillance definitions. Demographics, underlying diagnosis, CDI characteristics, drug exposure, and outcomes were analyzed. Risk factors for CDI recurrence were assessed by logistic regression. RESULTS: One hundred-eighty patients developed 305 CDI episodes; 233 (78%) were incident, 65 (22%) recurrent, and 7 duplicate and removed from the analysis. Recurrence occurred after 51 incident episodes (Table 1). Median age (range) was 5.7 (0.5–25.5) years. Underlying diagnoses were leukemia/lymphoma (56%) and solid/brain tumors (42%). 87 (29%) received HSCT. Almost all patients received antibiotics 4 weeks prior to CDI. 14% received laxatives 72 hours prior to CDI. 50% of patients were neutropenic. The median (range) duration of diarrhea was 10.0 (1–77). Thirty patients (15%) were hospitalized due to CDI, for a median (range) of 3 (1–49) days. 16% had a delay in chemotherapy due to CDI. There was no ICU admissions nor death due to CDI. None of the evaluated variables was identified as a significant risk factor for CDI recurrence by logistic regression (Table 3). CONCLUSION: CDI in pediatric oncology and transplant patients ran a generally mild course, associated with chemotherapy delay and hospitalization in a small fraction, and no attributable ICU admission nor death. CDI recurred in less than a quarter of patients. Risk factors for CDI recurrence were not identified. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: Randall Hayden, MD, Abbott Molecular: Advisory Board; Quidel: Advisory Board; Roche Diagnostics: Advisory Board