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Risk factors for the development of C lostridium difficile infection in adult allogeneic hematopoietic stem cell transplant recipients: A single‐center study in Q uébec, C anada
Author(s) -
Lavallée Christian,
Labbé AnnieClaude,
Talbot JeanDaniel,
Alonso Carolyn D.,
Marr Kieren A.,
Cohen Sandra,
Laverdière Michel,
Dufresne Simon Frédéric
Publication year - 2017
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.12648
Subject(s) - medicine , odds ratio , hematopoietic stem cell transplantation , mucositis , transplantation , clostridium difficile , risk factor , cytomegalovirus , incidence (geometry) , surgery , immunology , antibiotics , herpesviridae , viral disease , virus , chemotherapy , physics , optics , microbiology and biotechnology , biology
Background Clostridium difficile infection ( CDI ) is a significant complication of allogeneic hematopoietic stem cell transplantation (allo‐ HSCT ). Our primary objective was to determine risk factors for the development of CDI during the first year following allo‐ HSCT . Methods A matched case–control study nested in a cohort of allo‐ HSCT at a single hospital in Montréal, Québec, Canada, was conducted from 2002 through 2011. Results Sixty‐five of 760 patients who underwent allo‐ HSCT between 2002 and 2011 developed CDI , representing an incidence of 8.6%. We selected 123 controls matched for year of transplant for risk factor analyses. In the multivariable analysis, receipt of trimethoprim‐sulfamethoxazole ( TMP ‐ SMX ) prior to transplantation (adjusted odds ratio [ aOR ] 0.07, 95% confidence interval [ CI ] 0.02‐0.27), mucositis ( aOR 5.90, 95% CI 2.08‐16.72), and reactivation of cytomegalovirus ( CMV ) ( aOR 6.17, 95% CI 2.17‐17.57) and of other Herpesviridae viruses ( aOR 3.04, 95% CI 1.13‐8.16) were the variables that remained statistically associated with CDI . High‐risk antibiotic use in the late post‐transplant period ( aOR 7.63, 95% CI 2.14‐27.22) was associated with development of late CDI. Conclusion This study revealed reactivation of CMV and other Herpesviridae viruses as novel risk factors for CDI . Administration of TMP ‐ SMX prior to transplantation was independently associated with a decreased risk of CDI . Early and late CDI after HSCT may have distinct risk factors.

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