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Published on: December 8, 2014
Clostridioides difficile Colonization and Infection in Pediatric Oncology and Stem Cell Transplant Patients
Daniel N Willis1, Erik R Dubberke2, Robert J Hayashi1
1Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA.
Insights
Clostridioides difficile colonization is common in pediatric oncology and stem cell transplant patients, with asymptomatic individuals potentially spreading the infection. Gut microbiome diversity may influence colonization risk.
Area of Science:
- Infectious Diseases
- Microbiology
- Pediatric Hematology/Oncology
Background:
- Pediatric oncology and hematopoietic stem cell transplant (HSCT) patients face increased risk of Clostridioides difficile infection (CDI).
- CDI can lead to prolonged hospitalization and chemotherapy delays.
- Colonization precedes symptomatic CDI, making its characterization crucial.
Purpose of the Study:
- To characterize Clostridioides difficile colonization status in pediatric oncology and HSCT patients.
- To identify potential reservoirs and transmission dynamics of C. difficile in these vulnerable populations.
Main Methods:
- Retrospective study of 276 stool samples from 32 HSCT and 12 oncology patients over 34 months.
- Whole genome sequencing (WGS) for C. difficile strain typing and 16S rRNA gene sequencing for fecal microbiome analysis.
- Comparison of colonization rates and microbial diversity between patient cohorts.
Main Results:
- High baseline colonization rates observed: 50% in HSCT and 12% in oncology patients.
- Significant acquisition of colonization in initially negative patients (64% overall).
- Greater microbial diversity in C. difficile-positive stools for both oncology and HSCT cohorts.
Conclusions:
- C. difficile acquisition and colonization are frequent in pediatric oncology and HSCT patients.
- Clonally related strains found in multiple patients suggest asymptomatic carriers act as reservoirs.
- Gut microbial composition appears to influence the risk of C. difficile colonization.
Background:
Pediatric oncology and hematopoietic stem cell transplant (HSCT) patients have elevated risk for Clostridioides difficile infection (CDI), which can prolong hospitalization and delay chemotherapy. Colonization is an important prelude to symptomatic CDI. We sought to characterize colonization status in these patients.
Methods:
We retrospectively studied 276 stools longitudinally collected over 34 months from 32 HSCT and 12 oncology patients treated at a single tertiary center. Specimens were cultured for C difficile and compared by whole genome sequencing. The fecal microbiome was characterized by 16S rRNA gene sequencing.
Results:
Baseline cultures were positive in 16 (50%) HSCT patients and 2 (12%) oncology. On subsequent samples, 64% of patients who were initially negative acquired colonization: 8 of 15 (53%) HSCT and 8 of 10 (80%) oncology. Nine clonal strains and 25 multilocus sequence types were identified by whole genome sequencing, with 4 clones found in both cohorts. Nine patients had different strains at different time points. Seven clonal strains were found in multiple patients. Seven (15.9%) patients had symptomatic CDI. C difficile-positive stools had greater microbial diversity than negative stools in both the oncology cohort (Simpson diversity index, 0.07; 95% CI, .01-.14; P = .03) and the HSCT cohort (0.15; 95% CI, .07-.24; P < .001).
Conclusions:
C difficile acquisition and colonization are common in pediatric oncology and HSCT patients. The high prevalence of clonally related strains in multiple patients suggests that asymptomatic patients may be important reservoirs of this pathogen and lead to symptomatic CDI in some patients. Gut microbial composition may influence the risk of colonization.
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