Raymund Dantes1, Erin E Epson2, Samuel R Dominguez3, Susan Dolan4, Frank Wang5, Amanda Hurst4, Sarah K Parker3, Helen Johnston6, Kelly West4, Lydia Anderson5, James K Rasheed5, Heather Moulton-Meissner5, Judith Noble-Wang5, Brandi Limbago5, Elaine Dowell4, Joanne M Hilden3, Alice Guh5, Lori A Pollack5, Carolyn V Gould5. 1. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: vic5@cdc.gov. 2. Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA; Communicable Disease Epidemiology Section, Colorado Department of Public Health and Environment, Denver, CO. 3. Children's Hospital Colorado, Aurora, CO; University of Colorado School of Medicine, Aurora, CO. 4. Children's Hospital Colorado, Aurora, CO. 5. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA. 6. Communicable Disease Epidemiology Section, Colorado Department of Public Health and Environment, Denver, CO.
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Authors: Alice Y Guh; Susan Hocevar Adkins; Qunna Li; Sandra N Bulens; Monica M Farley; Zirka Smith; Stacy M Holzbauer; Tory Whitten; Erin C Phipps; Emily B Hancock; Ghinwa Dumyati; Cathleen Concannon; Marion A Kainer; Brenda Rue; Carol Lyons; Danyel M Olson; Lucy Wilson; Rebecca Perlmutter; Lisa G Winston; Erin Parker; Wendy Bamberg; Zintars G Beldavs; Valerie Ocampo; Maria Karlsson; Dale N Gerding; L Clifford McDonald Journal: Open Forum Infect Dis Date: 2017-10-26 Impact factor: 3.835
Authors: Bryan T Nycz; Samuel R Dominguez; Deborah Friedman; Joanne M Hilden; Diana Ir; Charles E Robertson; Daniel N Frank Journal: PLoS One Date: 2018-01-12 Impact factor: 3.240