Epidemiology, risk factors, and outcomes of C lostridium difficile infection in kidney transplant recipients

Background We sought to describe the epidemiology and risk factors for C lostridium difficile infection ( CDI ) among kidney transplant recipients ( KTR ) between 1 J anuary 2008 and 31 D ecember 2010. Methods A single‐institution retrospective study was conducted among all adult KTR with CDI , defined as a positive test for C . difficile by a cell cytotoxic assay for C . difficile toxin A or B or polymerase chain reaction test for toxigenic C . difficile . Results Among 603 kidney transplants performed between 1 J anuary 2008 and 31 D ecember 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%, P  = 0.08) standard‐risk patients. The overall rate of CDI increased from 3.7% in 2008 to 9.4% in 2010 ( P  = 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 E nterococcus colonization before transplant (odds ratio [ OR ]: 3.6, P  = 0.03), receipt of an organ from C enters for D isease C ontrol high‐risk donor ( OR : 5.9, P  = 0.006), and administration of high‐risk antibiotics within 30 days post transplant ( OR : 6.6, P  = 0.001). Conclusions 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 .