| Author |
Dantes, Raymund Epson, Erin E. Dominguez, Samuel R. Dolan, Susan Wang, Frank Hurst, Amanda Parker, Sarah K. Johnston, Helen West, Kelly Anderson, Lydia Rasheed, James K. Moulton-Meissner, Heather Noble-Wang, Judith Limbago, Brandi Dowell, Elaine Hilden, Joanne M. Guh, Alice Pollack, Lori A. Gould, Carolyn V. |
| Description |
Author Affiliation: Dantes R ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA); Epson EE ( Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA); Dominguez SR ( Children's Hospital Colorado, Aurora, CO); Dolan S ( Children's Hospital Colorado, Aurora, CO.); Wang F ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.); Hurst A ( Children's Hospital Colorado, Aurora, CO.); Parker SK ( Children's Hospital Colorado, Aurora, CO); Johnston H ( Communicable Disease Epidemiology Section, Colorado Department of Public Health and Environment, Denver, CO.); West K ( Children's Hospital Colorado, Aurora, CO.); Anderson L ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.); Rasheed JK ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.); Moulton-Meissner H ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.); Noble-Wang J ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.); Limbago B ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.); Dowell E ( Children's Hospital Colorado, Aurora, CO.); Hilden JM ( Children's Hospital Colorado, Aurora, CO); Guh A ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.); Pollack LA ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.); Gould CV ( Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.) |
| Abstract |
BACKGROUND: We investigated an increase in Clostridium difficile infection (CDI) among pediatric oncology patients. METHODS: CDI cases were defined as first C difficile positive stool tests between December 1, 2010, and September 6, 2012, in pediatric oncology patients receiving inpatient or outpatient care at a single hospital. A case-control study was performed to identify CDI risk factors, infection prevention and antimicrobial prescribing practices were assessed, and environmental sampling was conducted. Available isolates were strain-typed by pulsed-field gel electrophoresis. RESULTS: An increase in hospital-onset CDI cases was observed from June-August 2012. Independent risk factors for CDI included hospitalization in the bone marrow transplant ward and exposure to computerized tomography scanning or cefepime in the prior 12 weeks. Cefepime use increased beginning in late 2011, reflecting a practice change for patients with neutropenic fever. There were 13 distinct strain types among 22 available isolates. Hospital-onset CDI rates decreased to near-baseline levels with enhanced infection prevention measures, including environmental cleaning and prolonged contact isolation. CONCLUSION: C difficile strain diversity associated with a cluster of CDI among pediatric oncology patients suggests a need for greater understanding of modes and sources of transmission and strategies to reduce patient susceptibility to CDI. Further research is needed on the risk of CDI with cefepime and its use as primary empirical treatment for neutropenic fever. |
