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Risk factors associated with C lostridium difficile infection after kidney and pancreas transplantation
Author(s) -
Shah S.A.,
Tsapepas D.S.,
Kubin C.J.,
Martin S.T.,
Mohan S.,
Ratner L.E.,
Pereira M.,
Kapur S.,
Dadhania D.,
WalkerMcDermott J.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.12113
Subject(s) - medicine , leukopenia , incidence (geometry) , gastroenterology , pancreas , diarrhea , pancreas transplantation , kidney transplantation , population , kidney , chemotherapy , physics , environmental health , optics
Background C lostridium difficile infection ( CDI ) is a common cause of nosocomial antibiotic‐associated diarrhea with an increased incidence reported in solid organ transplant recipients. We sought to determine if kidney and/or pancreas transplant recipients possess unique risk factors for CDI . Methods Between J anuary 2009 and F ebruary 2011, 942 kidney and 56 pancreas transplants were performed at the 2 centers. Of these, 28 recipients (kidney, n = 24; pancreas, n = 4) developed CDI . Cases were matched to controls ( n = 56) in a 1:2 ratio. Results Those with CDI were mostly male patients (82% vs. 48%, P = 0.003), deceased‐donor organ recipients (86% vs. 64%, P = 0.045), more likely to have leukopenia (18% vs. 4%, P = 0.038), and had undergone a gastrointestinal procedure within 3 months preceding CDI diagnosis (18% vs. 4%, P = 0.038). Cases had higher cumulative and restricted antimicrobial exposure in days (37 ± 79 vs. 8 ± 12, P = 0.009 and 27 ± 69 vs. 7 ± 10, P = 0.032). Cephalosporin use was more common among cases (43% vs. 16%, P = 0.008). Conclusion Careful antimicrobial selection and assurance of optimal treatment duration in the kidney and pancreas transplant population is prudent. Clinicians should have a heightened awareness of CDI risk particularly during periods of leukopenia and in the setting of gastrointestinal procedures.