Pediatrics Commons^™

Regional Variation Of Underlying Kidney Diseases In Children Undergoing Chronic Kidney Replacement Therapy Around The Globe., Dagmara Borzych-Dużałka, Marjolein Bonthuis, Uma Ali, Yok-Chin Yap, Michael Manno, Yihui Zhai, Reyner Loza, Seema Hashmi, Naye Choi, Kenza Soulami, Judith Exantus, Mohamed S. Al Riyami, Sameh Mabrouk, Marbella Ma Angeles, Cristina Zelaya-Camacho, Henny Adriani Puspitasari, Syed Saimul Huque, Francisco Cano, Kar Hui Ng, Sevcan A. Bakkaloğlu, Jerome Harambat, Kitty J. Jager, Bradley A. Warady, Franz Schaefer

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: There is a scarcity of information regarding the distribution of the diseases leading to kidney failure (KF) in children living in the emerging world. We used registry data to provide a global overview of the underlying disease spectrum in children commencing kidney replacement therapy (KRT).

METHODS: We analyzed KF causes among 23,620 children and adolescents commencing maintenance KRT in 80 countries, using data from the IPNA Global KRT Registry (including ESPN/ERA Registry), the International Pediatric Dialysis Network (IPDN), the United States Renal Data System (USRDS), and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The analysis considered …

Promises, Pitfalls, And Paths Forward For The Pediatric Research Equity Act., Alexa L. Pagano, Danielle J. Green, Jennifer Goldman, Anjali Deshmukh

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Since its enactment in 2003, the Pediatric Research Equity Act (PREA) has significantly increased the number of pediatric drug studies performed and expanded pediatric drug labeling. Despite these advancements, many drugs used in children still lack pediatric-specific US Food and Drug Administration (FDA) labeling, even when pediatric studies are required by law. Recent legislative changes strengthened the FDA's enforcement authority over PREA. As these changes are implemented, persistent gaps in pediatric drug development warrant examination. Addressing these gaps may help ensure that children are systematically included in clinical research and that medications used in children are supported by rigorous …

American Epilepsy Society Clinical Practice Guideline: Infantile Epilepsy., Daniel Freedman, Ifeoluwa Babatunde, Rebecca L. Morgan, Renad Abu-Sawwa, Dara Albert, Mandana Behbahani, Kevin Chapman, Erin Day Fecske, William Davis Gaillard, Monika Jones, Mary Anne Meskis, Leah Schust Myers, Kim Nye, Chima Oluigbo, Heidi H. Pfeifer, Reneé A. Shellhaas, Lindsey Thompson, Howard L. Weiner, Courtney J. Wusthoff, Elissa Yozawitz

Manuscripts, Articles, Book Chapters and Other Papers

This practice guideline from the American Epilepsy Society provides evidence-based recommendations for pharmacological, dietary, and surgical therapies for epilepsy for infants and children from 1 month of age to < 36 months. The multidisciplinary panel updated an existing systematic review, which was funded by the Patient-Centered Outcomes Research Institute and conducted by ECRI (formerly the Emergency Care Research Institute) on behalf of the Agency for Healthcare Research and Quality. The updated review used the same search strategy, inclusion/exclusion criteria, and Grading of Recommendations Assessment, Development and Education methodology, and added studies from August 2021 through September 2025 that were not in the original systematic review. As with the previous review, West syndrome and infantile spasms were excluded from this guideline, as existing treatment guidance is already available for infantile epileptic spasms. While many of the recommendations are conditional due to low certainty of evidence, the panel made two strong recommendations: (1) hemispherectomy/hemispherotomy surgery is recommended for infants and children < 36 months of age with drug resistant epilepsy secondary to select underlying lesional pathologies, including but not limited to hemimegaloencephaly, Rasmussen's encephalitis, Sturge-Weber syndrome, perinatal stroke, and hemispheric cortical dysplasia; and (2) intralobar, multilobar, or focal resections or posterior disconnections for drug-resistant focal or lesional epilepsy in this same age range. A treatment algorithm was developed based on evidence and expert opinion as part of the guideline to help place pharmacological, dietary, and surgical recommendations in a clinical context. The limited number of studies and low certainty of evidence in this population underscores the need for higher-quality data and etiology-specific treatments. More research is needed to evaluate effective therapies for infants with epilepsy, as well as the impact these therapies have on long-term developmental and mortality outcomes.

Accelerated Weaning Of Opioids To Reduce Pharmacologic Exposure For Neonatal Opioid Withdrawal Syndrome: A Randomized Clinical Trial., Abbot R. Laptook, Adam Czynski, Rouba Chahine, Rachel G. Greenberg, P Brian Smith, Erica Oliveira, Jenna Gabrio, Barry Eggleston, Abhik Das, Jeannette Lee, Barry Lester, Dave Clark, Michele Walsh, Helen Ko, Clare Campbell Asher, Hayley Friedman, Samuel Gentle, Karishma Rao, Anup Katheria, Kristen Benninger, Sanket Jani, Mark Cody Smith, Akram Khan, Ajay Talati, Shaina Lodhi, Fernando Mena, Amanda England, Prabhu Parimi, Ranjit Kylat, Heidi Harmon, Javed Mannan, Meghan P. Howell, Tanner Wright, Jessica Snowden, Act Now Collaborative

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To determine if newborns receiving morphine or methadone as the primary pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS) tolerate and receive fewer days of opioid using an accelerated wean protocol (15% decrements) compared with using a slower wean protocol (10% decrements).

STUDY DESIGN: Newborns ≥36 weeks of gestation receiving morphine or methadone for NOWS were enrolled in a pragmatic blinded, randomized multicenter trial. Newborns underwent protocol-driven weaning with decreasing opioid doses of either 15% or 10% decrements. Weaning was encouraged every 24 hours, and if signs of NOWS worsened, the preceding dose was resumed. To maintain blinding, the …

Natural Maternal Immunity Protects Neonates From Escherichia Coli Sepsis., Raymond E. Diep, Ujjwal Adhikari, Kubra Gokce Tezel, Giang Pham, Allison R. Burrell, Mary A. Staat, Nguyen Thi Khanh Nhu, Minh-Duy Phan, Kate M. Peters, Mark A. Schembri, Scott H. Saunders, David B. Haslam, John J. Erickson, Susana Chavez-Bueno, Sing Sing Way

Manuscripts, Articles, Book Chapters and Other Papers

Escherichia coli is a leading cause of neonatal sepsis, with infection occurring in approximately one in every 1,000 live births. However, with E. coli colonization beginning soon after birth and defects in neonatal host defence maturation, an alternative consideration is why infection does not occur even more frequently. Here we show that newborn babies with E. coli sepsis have selectively reduced vertically transferred natural antibodies that recognize E. coli, mechanistically explaining their susceptibility to infection. Complementary preclinical studies show that preconceptual intestinal colonization with probiotic E. coli Nissle 1917 (EcN) primes anti-E. coli immunoglobulin G (IgG) antibodies with broad cross-reactivity …

Clinical Characteristics, Antibiotic Resistance Trends, And Associated Molecular Epidemiology Traits In Escherichia Coli Isolates Producing Neonatal Bacteremia, Keerti Ivaturi, Christine Symes, Mina Farahbakhsh, Sanjula Bhuri, Joshua L Wheatley, Rangaraj Selvarangan, Daniel P. Heruth, Susana Chavez-Bueno

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Escherichia coli is a leading cause of neonatal sepsis. This study's objective was to investigate the clinical characteristics of newborns with E. coli bacteremia, and recent antibiotic resistance trends and molecular epidemiologic features of these invasive strains.

METHODS: Clinical data and blood E. coli isolates collected from 54 neonates with bacteremia were studied. E. coli antibiotic susceptibility trends over time, and whole-genome sequencing data relevant to the genomic relatedness and capsule genotype of the isolates were analyzed.

RESULTS: Thirty percent of bacteremic newborns were preterm. Mortality was 19% in preterm versus 5% in term infants. Cerebrospinal fluid was collected …

Measuring School Anxiety In Pediatric Chronic Pain: Initial Investigation Of The Psychometric Properties Of The School Anxiety Inventory For Chronic Pain (Sai-Cp), Caitlyn Maye, Robert C. Gibler, Kristen E. Jastrowski, Dustin Wallace Phd, Cara M. Hoffart, Jenny Scheurich Phd

Posters

Introduction: School anxiety is common among adolescents with chronic pain and often impacts academic and social functioning. Existing anxiety measures lack specificity for capturing the unique sources and symptoms of school-related anxiety in this population. To address this gap, a bank of new potential measure items (the School Anxiety Inventory for Chronic Pain [SAI-CP]), was developed based on the original School Anxiety Inventory (SAI), qualitative interviews with adolescents with chronic pain, and expert clinician input. The objective of this study was to evaluate the construct validity and internal consistency of the SAI-CP and identify avenues for future measure refinement. Method: …

Recognizing What Matters Most: Using Safety-Critical Tasks To Strengthen Central Line-Associated Bloodstream Infection (Clabsi) Prevention Rounds, Lacey Bergerhofer, Christian Anthony Schneider, Emily Evans

Posters

Background: Our CLABSI improvement team developed high-risk rounding processes on the Hematology/Oncology unit. Expanding this model to additional Med/Surg units was challenging due to limited staffing and time-intensive tasks required during rounds. Concurrently, CLABSI rates across other Med/Surg units increased, necessitating a scalable approach. Objectives: Apparent Cause Analysis (ACA) review in Med/Surg units identified an opportunity to strengthen surveillance by engaging Vascular Access subject-matter experts. Our proactive high-risk rounds pilot led to CLABSI rate reduction. The objective was to expand service coverage without compromising established high-risk rounding quality standards. Our goal is to assess > 90% of central lines in Med/Surg …

Persistent Wheezing In An Adolescent Patient, Matilda Dervisevic, Stephen Cliff

Posters

No abstract provided.

Extracorporeal Membrane Oxygenation (Ecmo) Neuromonitoring And Acute Brain Injury, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Pertussis, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

The Dietary Management Of Sodium In Children With Kidney Diseases-Clinical Practice Recommendations From The Pediatric Renal Nutrition Taskforce., José Renken-Terhaerdt, An Desloovere, Michiel Js Oosterveld, Nonnie Polderman, Evelien Snauwaert, Stella Stabouli, Johan Vande Walle, Caroline Anderson, Sheridan Collins, Larry A. Greenbaum, Matthew Harmer, Lyndsay Harshman, Christina L. Nelms, Pearl Pugh, Vanessa Shaw, Jetta Tuokkola, Molly R Wong Vega, Bradley A. Warady, Rukshana Shroff, Fabio Paglialonga

Manuscripts, Articles, Book Chapters and Other Papers

Sodium imbalance is a common concern in children with kidney diseases, presenting as either sodium excess or sodium deficit, each with significant clinical implications. Sodium excess contributes to fluid overload and hypertension, while increased sodium losses, particularly via urine or peritoneal fluid, can predispose patients to hypotension and growth failure. Effective sodium management is thus a critical component of care in pediatric kidney diseases, with dietary sodium intake playing a pivotal role in maintaining homeostasis. The Pediatric Renal Nutrition Taskforce (PRNT) has developed clinical practice recommendations (CPRs) for dietary sodium management in children with kidney diseases, addressing key aspects of …

Croup, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Clinical Practice Guidelines)

No abstract provided.

Digital Ischemia, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Croup: Associated Symptoms With Admission, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Early Neurologic Red Flags In Pediatrics: What Primary Care Providers Need To Know, Bob Underwood, Justin Coogle

Pediatrics in Practice: A CME Podcast

Subtle neurologic symptoms can be easy to miss in primary care. Pediatric neurologist Justin Coogle, MD, reviews early red flags, age‑specific warning signs and referral considerations to help pediatricians identify neurologic disorders earlier and optimize care.

Click here to stream the podcast episode.

Seeing Surgery Differently: The Role Of Virtual Reality In Pediatric Care, Bob Underwood, Mark Ryan

Pediatrics in Practice: A CME Podcast

Virtual reality is changing how pediatric surgeons plan procedures, educate care teams and help children and families better understand what to expect. In this episode, Mark Ryan, MD, pediatric surgeon, discusses how virtual reality is being used in pediatric surgery today, its impact on patient experience and surgical planning and what pediatricians should know as this technology continues to evolve.

Click here to stream the podcast episode.

Genetic Predispositions To Cancer: What Pediatricians Need To Know, Sarah Gubara, Nicole Wood

Pediatrics in Practice: A CME Podcast

Pediatric hematology/oncology physician Nikki Wood, DO, explains how pediatricians can recognize genetic cancer risk, refer to genetics appropriately, and support families through long‑term surveillance.

Click here to stream the podcast episode.

Acute Musculoskeletal Injuries In Kids—Assessment, Imaging & Return-To-Play, Mike Smith, Kevin Latz Md

Pediatrics in Practice: A CME Podcast

How should pediatricians triage an acute sports injury—what to check first, what imaging to order, and when to escalate urgently? In this Pediatrics in Practice CME episode, Kevin Latz, MD, MBA shares a practical framework for assessment, red flags, return-to-play counseling, and prevention strategies for active kids.

Click here to stream the podcast episode.

Choice-Aya: Adapting An Evidence-Based Contraceptive Counseling Intervention For Adolescents And Young Adults Experiencing Homelessness., Mariah E. Brewe, Anna Burns, Nikolaus Schuetz, Taylor Stephens, Emma Francis, Haylie Yost, Stephani L. Stancil

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Adolescents and young adults (AYA) experiencing homelessness face an increased risk of reproductive violence, unintended pregnancy, and barriers accessing healthcare. While interventions focused on efficacy-first contraceptive counseling are successful at increasing rates of long-acting reversible contraceptive (LARC) use, little is known about how an efficacy-first approach is received by AYA experiencing homelessness given unique factors associated with their reproductive health care. We aimed to adapt the evidence-based CHOICE contraceptive counseling approach for AYA experiencing homelessness.

METHODS: Focus groups discussion with AYA experiencing homelessness were conducted to understand prior reproductive health care experiences and contraception counseling preferences, comparing efficacy first …

Cardiomyopathy In Children: What Pediatricians Need To Know, Michael Smith, Brian Birnbaum

Pediatrics in Practice: A CME Podcast

Cardiomyopathy in children can present with subtle signs but serious consequences if missed. In this episode, Brian Birnbaum, MD, Interim Co-Director of the Ward Family Heart Center at Children’s Mercy, shares practical insights for pediatricians on recognizing early red flags, knowing when to refer, and understanding how diagnosis and management of pediatric cardiomyopathy are evolving.

Click here to stream the podcast episode.

Inside The Therapy Room: What Really Happens In A Session With Your Kid, Maggie Mckay, Haley J. Killian

Parent-ish Podcast

Ever wonder what your kid actually does in therapy? In this episode, pediatric psychologist Haley Killian, PhD, gives us a simple, behind‑the‑scenes look at what happens in a session—play, feelings, progress and all. It’s real talk, zero judgment, and plenty of reassurance for any parent curious about whether therapy could help their kid.

Click here to stream the podcast episode.

Health Disparities For Pneumonia And Sinusitis Antibiotic Treatment In The Emergency Department, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Rana El Feghaly Md

Posters

Optimal antibiotic selection and duration are pillars of antimicrobial stewardship efforts. In our emergency department (ED), >80% of community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS) are treated with first-line (FL) guideline-concordant antibiotics. Differences in care based on socioeconomic factors (race, ethnicity, language, and insurance status) have not been characterized. We sought to compare differences in antibiotic choice and duration for different socioeconomic factors, and analyze changes after quality improvement (QI) efforts. Multidisciplinary QI team used multiple Plan- Do-Study-Act cycles and was successful in improving antibiotic duration for CAP and ABRS from a baseline of 13% to 61% (January …

Clinical And Non-Clinical Factors Associated With Early Discharge In Pediatric Non-Trauma Patients Transported By Rotor Wing, Jordon Mitzelfelt, Lisa Pruitt, Amy Papa, Ashley K. Sherman, David Juang, Sarah Brunner, Asdis Finnsdottir Wagner, Jennifer Flint

Posters

Objective: Helicopter emergency medical services (HEMS) are crucial for transporting critically ill children to definitive care, however, rising costs and relative risks of this type of transportation necessitate careful evaluation of potential over-utilization. Current literature primarily focuses on pediatric trauma patients, leaving a significant gap in data regarding non-trauma pediatric HEMS transports and the influence of non-clinical factors such as referral hospital distance, resources, and capabilities on transport decisions. This study aims to address these gaps by examining non-trauma pediatric HEMS patients and identifying associated clinical and non-clinical factors related to early hospital discharge (< 24 hours). Methods: This retrospective, single-center study includes pediatric patients with medical and non-trauma surgical diagnoses transported by HEMS between April 1, 2021 and March 31, 2024. Clinical data were extracted from transport team records and the hospital’s electronic health records. Analyses were performed to identify factors associated with discharge within 24 hours of admission. To identify predictors of early discharge, we analyzed clinical factors including chief complaint, pre-transport vascular access, transport crew interventions (medication administration and procedures), respiratory assistance, and Pediatric Age-Adjusted Shock Index (SIPA) scores. Additionally, we examined the impact of the initial admit unit, and medical support required within the first 24 hours of hospitalization. Non-clinical predictors included the referring hospital’s status (critical access and/or rural designation) and the time of transport. Results: A total of 568 patients were transported by HEMS, of whom 88 (15%) were discharged within 24 hours. Patients in the early discharge group were more likely to present with neurologic chief complaints (40%), whereas those remaining hospitalized beyond 24 hours more frequently presented with respiratory complaints (40%). Normal SIPA scores both prior to and at the conclusion of transport were significantly associated with early discharge (p=0.012 and p=0.011, respectively). Furthermore, patients requiring no medications or respiratory assistance during transport, or no respiratory support within the first 24 hours of admission, were significantly more likely to be discharged early (p< 0.001). Notably, all patients with central access prior to transport remained admitted for more than 24 hours (p=0.004). Regarding non-clinical factors, patients transported from designated rural hospitals were more likely to experience early discharge (p< 0.001). Conclusion: These results characterize the pediatric non-trauma HEMS population and identify key predictors of early hospital discharge. This data is essential for developing standardized dispatch criteria to mitigate over-utilization and ensure high-acuity transport is reserved for the most appropriate patients.

Does Variation In Systemic Steroid Use Impact Outcomes In Preschoolers Hospitalized With Viral Respiratory Tract Infection?, Smit Shah, Kathryn Kyler, Matt Hall, Jessica Markham

Posters

Background: Systemic corticosteroids (SCS) are a cornerstone of treatment for acute asthma exacerbation. However, the role of SCS in preschool-aged children hospitalized with viral respiratory tract infection (vRTI), including viral induced wheezing, remains uncertain. Clinical trials have reported conflicting results about the benefits of SCS in this population. Objectives: To evaluate hospital-level variation in inpatient management of preschool-aged children admitted with vRTI and to compare clinical and utilization outcomes based on hospital-level SCS use. Methods: We conducted a retrospective cohort study of children aged 24-59 months admitted to US children’s hospitals with vRTI from July 2022-July 2024 using the Pediatric …

Reducing Waste And Cost By Utilizing Tap Water For Laceration Irrigation In The Emergency Department: A Quality Improvement Approach, Alison L. Fowler, Rohan Akhouri, Josaih Galdean, Isabella Dunt, Christopher Kaberline, Viktoriya Stoycheva Mha, Rn, Cpn, Sarah Nienhaus, Leslie Hueschen

Posters

Purpose/Objective: Lacerations requiring closure make up 8 million emergency department (ED) visits annually. Irrigating prior to closure with potable tap water decreases cost and waste without increasing rates of infection compared to sterile fluids. Currently, only 3.5% of lacerations closed in our ED are irrigated with tap water. This project aims to increase the percent age of lacerations closed by ED providers irrigated with tap water from 3.5% to 60% by March 2026 in a freestanding pediatric emergency department across two sites (ED 1, ED 2). Design/Methods: A multidisciplinary team (physicians, nurses, QI consultant, parent advisors) formed in November 2024. …

Resilience Factors For Physical Activity After Completion Of Intensive Interdisciplinary Pain Treatment: A Qualitative Analysis., William R. Black, Lora L. Black, Jennifer Christofferson, Liesbet Goubert, Cara M. Hoffart, Dustin Wallace

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: This study explored potential resilience factors that facilitate engagement in physical activity (PA) among adolescents with chronic musculoskeletal pain after completing intensive interdisciplinary pain treatment.

METHODS: Ten adolescents aged 13 to 17 years with a history of chronic musculoskeletal pain from a mid-western pediatric hospital in the United States participated in this qualitative study. Participants provided demographic information and completed semistructured virtual interviews. The interviews focused on their pain experiences, resilience, and engagement in PA. Transcripts were analyzed using primarily directed content analysis based on a pain resilience framework.

RESULTS: Participants highlighted several key resilience factors that influenced their …

Cardiac Medication Use In Action For Duchenne Muscular Dystrophy Cardiomyopathy., Carol A. Wittlieb-Weber, Brian Birnbaum, Chesney D. Castleberry, Tyler W. Cunningham, Paul Esteso, Katheryn E. Gambetta, Emily A. Hayes, Daphne T. Hsu, Beth D. Kaufman, Benjamin Kroslowitz, Ashwin K. Lal, Angela Lorts, Hugo Martinez, Deepa Mokshagundam, Deipanjan Nandi, John J. Parent, Frank Raucci, Nelia Soares, Jonathan H. Soslow, Renata Shih, Svetlana Shugh, Chet R. Villa, Sarah J. Wilkens, Bethany L. Wisotzkey, Jennifer Conway

Manuscripts, Articles, Book Chapters and Other Papers

This study seeks to understand cardiac medication use in a large cohort of males with Duchenne Muscular Dystrophy (DMD) followed prospectively with focus on current practices and adherence to consensus directed medical therapy (CDMT). DMD patients have been enrolled in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Dystrophinopathy Registry since 2021. Cardiac medication use was analyzed at enrollment and most recent follow-up. CDMT was defined as concurrent use of angiotensin-converting-enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) /angiotensin receptor-neprilysin inhibitor (ARNI) plus beta-blocker (BB) plus mineralocorticoid receptor antagonist (MRA). Two hundred sixty-five males with DMD (median age 17.5 (IQR 14.5-21.5) …

Proximal And Distal Factors Associated With Obesity In Childhood: An Exploratory Structural Equation Model., Joseph A. Skelton, Erinn T. Rhodes, Sarah Hampl, Ihuoma Eneli, Edward H. Ip, Sit Study Research Group

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Obesity in childhood is complex; structural equation modeling (SEM) offers an approach to ascertain complicated relationships between weight and proximal (health behaviors, child health) and distal (family/household, community) variables. The objective of the study was to use SEM to map the influence of different etiological clusters on obesity in childhood.

METHODS: Secondary analysis of baseline data from patients and parents enrolled in a multi-site study of pediatric weight management was conducted. The primary outcome was weight status (utilizing percentage above the 95th percentile BMI, %95BMI). SEM was used to evaluate the influences of variables proximal and distal to child …

Clostridioides Difficile Colonization And Infection In Pediatric Oncology And Stem Cell Transplant Patients, Daniel N. Willis, Erik R. Dubberke, Robert J. Hayashi, Phillip I. Tarr, David B. Haslam, Tiffany Hink, Jingqin Luo, Yu Tao, Amruta Padhye, Erin Hall, Gregory A. Storch

Manuscripts, Articles, Book Chapters and Other Papers

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 …