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Epidemiology, risk factors, and outcome of Clostridium difficile infection in heart and heart‐lung transplant recipients
Author(s) -
Bruminhent Jackrapong,
Cawcutt Kelly A.,
Thongprayoon Charat,
Petterson Tanya M.,
Kremers Walter K.,
Razonable Raymund R.
Publication year - 2017
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.12968
Subject(s) - medicine , clostridium difficile , proportional hazards model , heart transplantation , risk factor , epidemiology , diarrhea , lung transplantation , gastroenterology , retrospective cohort study , transplantation , surgery , antibiotics , microbiology and biotechnology , biology
Background Clostridium difficile is a major cause of diarrhea in thoracic organ transplant recipients. We investigated the epidemiology, risk factors, and outcome of Clostridium difficile infection ( CDI ) in heart and heart‐lung transplant ( HT ) recipients. Methods This is a retrospective study from 2004 to 2013. CDI was defined by diarrhea and a positive toxigenic C. difficile in stool measured by toxin enzyme immunoassay (2004‐2006) or polymerase chain reaction (2007‐2013). Cox proportional hazards regression was used to model the association of risk factors with time to CDI and survival with CDI following transplantation. Results There were 254 HT recipients, with a median age of 53 years ( IQR , 45‐60); 34% were female. During the median follow‐up of 3.1 years ( IQR , 1.3‐6.1), 22 (8.7%) patients developed CDI . In multivariable analysis, risk factors for CDI were combined heart‐lung transplant ( HR 4.70; 95% CI , 1.30‐17.01 [ P =.02]) and retransplantation ( HR 7.19; 95% CI , 1.61‐32.12 [ P =.01]). Acute cellular rejection was associated with a lower risk of CDI ( HR 0.34; 95% CI , 0.11‐0.94 [ P =.04]). CDI was found to be an independent risk factor for mortality ( HR 7.66; 95% CI , 3.41‐17.21 [ P <.0001]). Conclusions Clostridium difficile infection after HT is more common among patients with combined heart‐lung and those undergoing retransplantation. CDI was associated with a higher risk of mortality in HT recipients.