scholarly journals Epidemiology of Clostridium difficile infection Among Patients with Newly Diagnosed or Relapsed Acute Leukemia: A Single-center Experience

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S391-S392
Author(s):  
Alexandra Franco Garcia ◽  
Tracy McMillen ◽  
Hoi Yan Chow ◽  
Janet Eagan ◽  
Janine Sun ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Acute Leukemia ◽  
Clostridium Difficile Infection ◽  
Hematologic Malignancy ◽  
Cancer Center ◽  
Cell Transplant ◽  
Newly Diagnosed ◽  
Single Center Experience ◽  
Toxigenic Culture ◽  
Relapsed Disease

Abstract Background Patients undergoing treatment for hematologic malignancy are at a higher risk for developing Clostridium difficile infection (CDI). We sought to determine the epidemiology of toxigenic C. difficile (TCD) carriage and CDI incidence among patients undergoing with newly diagnosed or relapsed acute leukemia. Methods Serial stool samples were collected from 92 patients with new or relapsed acute leukemia admitted at Memorial Sloan Kettering Cancer Center between August 26, 2011 to January 22, 2013. Only the first hospitalization during this time period was included. Screening was performed by toxigenic culture and polymerase chain reaction for tcdB gene regardless of symptoms of diarrhea. Genotyping was done by Multi Locus Sequence Typing (MLST). Acquisition of TCD, development of CDI, and associated clinical variables were recorded. Results A total of 92 patients were enrolled in the study. The mean age was 54.3 (median 57.5, range 21–86), 51 were male (55%). The majority (86, 93%) had newly diagnosed acute leukemia and 7% had relapsed disease. 60 patients (65%) had recent healthcare-related exposure, among these were 35 (38%) patients newly referred another facility. The most common chemotherapy regimen was Daunorubicin + Cytarabine in 71 subjects (77%). Systemic antibiotics of any duration during the same hospitalization were used in 89 patients (97%). Median length of stay (LOS) was 30.5 days (range 6–140 days). Among the 92 subjects, 17 developed CDI within 90 days (18%), 12 (71%) had CDI during the index admission. Five among these 12 had known TCD colonization, genotyping of colonizing and CDI strains from the same patients were identical for all patients. CDI in subsequent hospitalizations occurred in 5 patients, 4/5 were new acquisitions. One patient with TCD colonization never developed CDI. 53 subjects (58%) underwent stem cell transplant at a median time of 4 months (range 2–19 months), 8 (15%) developed CDI within 30 days of the transplant admission. Conclusion CDI is exceedingly common among patients with acute leukemia. Acquisition of TCD and CDI occurs early in the treatment course. Approximately half of infections occur in patients with known TCD colonization. Extended LOS and high antibiotic usage are contributors to the high burden of CDI among this population. Disclosures All authors: No reported disclosures.

scholarly journals 2390. Acquisition of Clostridium difficile Infection Following Exposure from Roommate Defined by Concordance on Genotyping

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S825-S825
Author(s):  
Anoshé Aslam ◽  
Tracy McMillen ◽  
Jonathan Wills ◽  
Nagla Bayoumi ◽  
Shauna Usiak ◽  
...  
Keyword(s):  
Risk Factor ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Observational Studies ◽  
Index Case ◽  
Multi Locus Sequence Typing ◽  
Spatial Proximity ◽  
Hospital Patient ◽  
Newly Diagnosed

Abstract Background Observational studies have identified same room occupancy with a hospital-onset Clostridium difficile infection (HO-CDI) case as a risk factor for subsequent CDI diagnosis. Despite this, the risk remains poorly characterized in endemic settings. Furthermore, genotyping techniques have not been applied to examine concordance between infecting strains in index patients and exposed roommates who eventually develop CDI. The study seeks to quantify transmission of C. difficile from an index case to their roommates and identify if concordance was present among strain types by the application of multi-locus sequence typing (MLST). Methods Laboratory-identified cases of hospital onset C. difficile infection (CDI) from October 1, 2017 through March 31, 2018, were included in the study. Patients with HO-CDI are placed in private room once diagnosis is established. Roommates who were in the same room as cases for at least 24 hours prior to diagnosis, regardless of duration of overlap, were identified through of the hospital patient tracking database to establish spatial link. Next, all exposed roommates who developed CDI within 3 months after exposure (defined as date of CDI diagnosis of index case) were identified. Strain types of linked cases was examined by MLST. Results During the 6-month period, 279 cases of CDI were diagnosed. Of these cases, 156 were hospitalized at the time of diagnosis including 83 (53%) in a room with shared occupancy. These 83 patients had 109 roommates that met exposure criteria. Four (3.7%) roommates developed CDI over a 90-day follow-up period. None of the examined pairs were genetically concordant. Conclusion Indirect patient to patient transmission of C. difficile from newly diagnosed CDI cases to roommates is not common despite the spatial proximity with shared occupancy. Disclosures All authors: No reported disclosures.

scholarly journals Assessment of 1112 Newly Diagnosed Multiple Myeloma Patients According to Age and Year of Diagnosis at a Referral Cancer Center

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 29-30
Author(s):  
Jule F Vasquez ◽  
Edgar Diaz ◽  
Ebert Poquioma
Keyword(s):  
Multiple Myeloma ◽  
Latin American ◽  
Autologous Transplantation ◽  
Age At Diagnosis ◽  
Cancer Center ◽  
Cell Transplant ◽  
Age Group ◽  
Newly Diagnosed ◽  
Hematopoietic Stem ◽  
Male Patients

Background Multiple Myeloma is the second more frequent hematological malignancy with a median age at diagnosis of 65 years old. However, this data is mainly of European countries and the United State of America. (1) The age is an important variable because the vast majority of cancer center use 65-70 years old as the cutoff for autologous transplantation. Two third of patients are considered not eligible for autologous transplant. The percentage of patients diagnosed at young age (<40 years) is relatively rare (2,2%)(1, 2) and even more rare is before 30 years (0.3%)(3). It is not available solid information of Latin American MM patients. The objective of this study was to determine the age at diagnosis according to the last 19 years. Also, to define the percentage of MM patients in a 5-year interval range of age. Methods We reviewed the database of the Department of Epidemiology at the National Institute of Neoplastic Diseases from 2000 to 2018 in Lima, Peru. We included all patients with Multiple Myeloma. Stratification was made based of age group, year of diagnosis and eligibility for hematopoietic stem cell transplant. Tables of relative and accumulative frequency were made. Results We found 1112 patients with newly diagnosed MM (NDMM), with a median age of 61 years and an average of 60.2 years. Male patients were 59% for the entire cohort. Patients under 40 years of age represented 4.6% (51), of which 72% (37) were male. Those under 30 years old were 0.9% (10%) of all cases of which 90% were male. Patients eligible for transplant were 63% in total, with a median age of 55 years, and the non-eligible group had a median age of 71 years. The median age for each year from 2000 to 2018 was 61 with a range of 56 to 65 years old (peak in 2010) with an oscillating trend, however with a slight downward slope. The median age from 2000 to 2008 was 61 and from 2009 to 2018 was 60 years. The most frequent affect group was 60 to 64 years (16.5%), nevertheless, in the last 10 years the age group of 55-59 was the most affected 16.05% vs 15.34%, respectively. Conclusion: Our study shows that NDMM patients in Peru have a lower median age compared to European or American countries with a tendency to have younger MM patients. In addition to having a higher percentage (4.6% vs 2%) of patients under 40 years old and 30 years old (0.9% vs 0.3%). This significantly younger population and specially those under 40 years of age deserve a comprehensive evaluation to determine if this impact their prognosis and survival. References 1. Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21-33. 2. Blade J, Kyle RA, Greipp PR. Presenting features and prognosis in 72 patients with multiple myeloma who were younger than 40 years. Br J Haematol. 1996;93(2):345-51. 3. Blade J, Kyle RA, Greipp PR. Multiple myeloma in patients younger than 30 years. Report of 10 cases and review of the literature. Arch Intern Med. 1996;156(13):1463-8. Disclosures No relevant conflicts of interest to declare.

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