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Epidemiology, risk factors, and outcomes of C lostridium difficile infection in kidney transplant recipients
Author(s) -
Neofytos D.,
Kobayashi K.,
Alonso C.D.,
CadyReh J.,
Lepley D.,
Harris M.,
Desai N.,
Kraus E.,
Subramanian A.,
Treadway S.,
Ostrander D.,
Thompson C.,
Marr K.
Publication year - 2013
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/tid.12030
Subject(s) - medicine , odds ratio , epidemiology , kidney transplantation , transplantation , immunology , gastroenterology
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 .