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Clostridium difficile colitis in patients after kidney and pancreas–kidney transplantation
Author(s) -
Keven K.,
Basu A.,
Re L.,
Tan H.,
Marcos A.,
Fung J.J.,
Starzl T.E.,
Simmons R.L.,
Shapiro R.
Publication year - 2004
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/j.1399-3062.2004.00040.x
Subject(s) - medicine , clostridium difficile colitis , toxic megacolon , gastroenterology , colectomy , clostridium difficile , diarrhea , kidney transplantation , transplantation , metronidazole , incidence (geometry) , surgery , antibiotics , ulcerative colitis , physics , disease , optics , microbiology and biotechnology , biology
Limited data exist about Clostridium difficile colitis (CDC) in solid organ transplant patients. Between 1/1/99 and 12/31/02, 600 kidney and 102 pancreas–kidney allograft recipients were transplanted. Thirty‐nine (5.5%) of these patients had CDC on the basis of clinical and laboratory findings. Of these 39 patients, 35 have information available for review. CDC developed at a median of 30 days after transplantation, and the patients undergoing pancreas–kidney transplantation had a slightly higher incidence of CDC than recipients of kidney alone (7.8% vs. 4.5%, P >0.05). All but one patient presented with diarrhea. Twenty‐four patients (64.9%) were diagnosed in the hospital, and CDC occurred during first hospitalization in 14 patients (40%). Treatment was with oral metronidazole (M) in 33 patients (94%) and M+oral vancomycin (M+V) in 2 patients. Eight patients had recurrent CDC, which occurred at a median of 30 days (range 15–314) after the first episode. Two patients (5.7%) developed fulminant CDC, presented with toxic megacolon, and underwent colectomy. One of them died; the other patient survived after colectomy. CDC should be considered as a diagnosis in transplant patients with history of diarrhea after antibiotic use, and should be treated aggressively before the infection becomes complicated.