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The rise of C lostridium difficile infection in lung transplant recipients in the modern era
Author(s) -
Lee Janet T.,
Hertz Marshall I.,
Dunitz Jordan M.,
Kelly Rosemary F.,
D'Cunha Jonathan,
Whitson Bryan A.,
Shumway Sara J.
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12064
Subject(s) - medicine , clostridium difficile , incidence (geometry) , lung transplantation , retrospective cohort study , confounding , proportional hazards model , hazard ratio , multivariate analysis , transplantation , mortality rate , surgery , confidence interval , physics , optics , microbiology and biotechnology , biology , antibiotics
Abstract Purpose Clostridium difficile infection ( CDI ) rates have been rising in recent years. We aimed to characterize CDI in lung transplant recipients in the modern era and hypothesized that CDI would increase the mortality risk. Methods We performed a retrospective chart review of patients undergoing transplantation at our center from 1/2006 to 7/2011. Attributes of CDI + and CDI − groups were compared using Student's t ‐ and chi‐square tests (α = 0.05). Multivariate C ox proportional hazard models were used to control for confounding factors. Results Overall CDI incidence was 22.5%. Seven of 151 patients (4.6%) developed CDI during the initial hospitalization after transplantation (mean time 10.6 ± 6 d) while 27 patients (19.7%) developed CDI after discharge (mean time 467 ± 471 d). Incidence rate was 224.6 cases/100 000 patient‐days compared to 110 cases/100 000 patient‐days (rate for entire hospital). CDI was not predictive of mortality ( HR 2.06, 95% CI 0.94–4.52). Conclusion CDI rates in lung transplant recipients are high in the modern era. No risk factors for CDI were identified. Although not statistically significant, CDI + patients had a higher risk of death. The economic burden of CDI and trend toward worse outcomes for CDI patients have important implications for post‐operative surveillance of CDI ‐related complications and need for CDI prophylaxis.

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