Evaluation of Bloodstream Infections, Clostridium difficile Infections, and Altered Gut Microbiota in Pediatric Oncology Patients. (4th October 2017)

• Record Type: Journal Article
• Authors: Nycz, Bryan; Dominguez, Samuel R; Frank, Daniel
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S234
• Page End: S235
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.494
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Bloodstream infections (BSI) and Clostridium difficile infections (CDI) in pediatric populations with underlying malignancies are frequent complications associated with significant morbidity and mortality. The relationship between the development of these infections and changes in the gastrointestinal microbiome have not been studied in detail. The purpose of this study was to explore possible associations between altered microbiome composition and the occurrence of BSI and CDI in a small, convenience cohort of pediatric oncology patients. Methods: As part of a CDI outbreak investigation, stool samples were collected from all patients admitted to the pediatric oncology floor from Oct–Dec 2012. Stool samples were tested for the C. difficile toxin B gene by PCR. Bacterial profiles from patient stools were determined by broad-range PCR of bacterial 16S rRNA genes and phylogenetic sequence analysis. Differences in microbiome composition were assessed by a non-parametric multivariate analysis of variance (PERMANOVA) test, while differences in the relative abundances of specific taxa were assessed by a Wilcoxon rank based test. Results: At admission, 9 of 42 patients (21%) were colonized with C. difficile . Furthermore, 5 patients (12%) previously had a BSI and 7 patients (17%) subsequently developed a BSI. Differences in overall microbiome composition were significantly associated with cancer type ( P < 0.01), chemotherapy treatment ( P <0.008), reason for admission ( P < 0.05; i.e., new cancer diagnosis, chemotherapy treatment visit, fever and neutropenia), subsequent BSI ( P < 0.001), and subsequent CDI ( P <0.04). Several bacterial taxa differed significantly between subjects with subsequent CDI vs. no CDI, including Ruminococcaceae ( P < 0.02), Blautia ( P < 0.03), and Clostridium ( P < 0.02). Additionally, multiple bacterial groups varied significantly between subjects with subsequent BSI vs. no BSI, including Ruminococcaceae ( P < 0.006), Faecalibacterium ( P < 0.0002), Clostridiales ( P < 0.006), and Enterococcus ( P < 0.007). Conclusion: Within this pediatric population, our results suggest that differences in microbiome composition may be predictive of subsequent bloodstream and C. difficile infections. A prospective study is required to further explore these relationships. Disclosures: All authors: No reported disclosures.