Epidemiology, risk factors, and outcomes of Clostridium difficile infection in kidney transplant recipients. Issue 2 (23rd November 2012)

• Record Type: Journal Article
• Authors: Neofytos, D.; Kobayashi, K.; Alonso, C.D.; Cady‐Reh, J.; Lepley, D.; Harris, M.; Desai, N.; Kraus, E.; Subramanian, A.; Treadway, S.; Ostrander, D.; Thompson, C.; Marr, K.
• Is Part Of: Transplant infectious disease. Volume 15:Issue 2(2013)
• Page Start: 134
• Page End: 141
• Publication Date: 2012-11-23
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12030
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" id="tid12030-abs-0001"> <title>Abstract</title> <sec id="tid12030-sec-0001" sec-type="section"> <title>Background</title> <p>We sought to describe the epidemiology and risk factors for <italic>Clostridium difficile</italic> infection (CDI) among kidney transplant recipients (KTR) between 1 January 2008 and 31 December 2010.</p> </sec> <sec id="tid12030-sec-0002" sec-type="section"> <title>Methods</title> <p>A single‐institution retrospective study was conducted among all adult KTR with CDI, defined as a positive test for <italic>C. difficile</italic> by a cell cytotoxic assay for <italic>C. difficile</italic> toxin A or B or polymerase chain reaction test for toxigenic <italic>C. difficile</italic>.</p> </sec> <sec id="tid12030-sec-0003" sec-type="section"> <title>Results</title> <p>Among 603 kidney transplants performed between 1 January 2008 and 31 December 2010, 37 (6.1%) patients developed CDI: 12 (of 128; 9.4%) high‐risk (blood group incompatible and/or anti‐human leukocyte antigen donor‐specific antibodies) vs. 25 (of 475; 5.3%, <italic>P</italic> = 0.08) standard‐risk patients. The overall rate of CDI increased from 3.7% in 2008 to 9.4% in 2010 (<italic>P</italic> = 0.05). The median time to CDI diagnosis was 9 days, with 27 (73.0%) patients developing CDI within the first 30 days after their transplant, and 14 (51.8%) developing CDI within 7 days. A case–control analysis of 37 CDI cases and 74 matched controls demonstrated the following predictors for CDI among KTR: vancomycin‐resistant <italic>Enterococcus</italic> colonization before transplant (odds ratio [OR]: 3.6, <italic>P</italic> = 0.03), receipt of an organ from Centers for Disease Control high‐risk donor (OR: 5.9, <italic>P</italic> = 0.006), and administration of high‐risk antibiotics within 30 days post transplant (OR: 6.6, <italic>P</italic> = 0.001).</p> </sec> <sec id="tid12030-sec-0004" sec-type="section"> <title>Conclusions</title> <p>CDI remains a common early complication in KTR, with rates steadily increasing during the study period. Host and transplant‐related factors and exposure to antibiotics appeared to significantly impact the risk for CDI among KTR.</p> </sec> </abstract>