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Risk factors associated with Clostridium difficile infection in kidney transplant recipients
Author(s) -
Spinner M.L.,
Stephany B.R.,
Cerrato P.M.,
Lam S.W.,
Neuner E.A.,
Patel K.S.
Publication year - 2018
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.12918
Subject(s) - medicine , clostridium difficile , kidney transplant , kidney transplantation , clostridium infections , intensive care medicine , microbiology and biotechnology , kidney , antibiotics , biology
Background Solid organ transplant recipients are especially vulnerable to Clostridium difficile infection ( CDI ) due to cumulative risk factors including increased exposure to healthcare settings, persistent immunosuppression, and higher rates of antimicrobial exposure. We aimed to identify risk factors associated with CDI development in kidney transplant recipients including implications of immunosuppressive therapies and acid‐suppressing agents. Methods This was a single‐center, non‐interventional, retrospective case‐control study of adult subjects between June 1, 2009 and June 30, 2013. During this time, 728 patients underwent kidney transplantation. Overall, 22 developed CDI (cases) and were matched 1:3 with 66 controls. Cases and controls were also matched for induction agent, kidney allograft type (living or deceased), and time from transplant to CDI result (±60 days). Results The majority of subjects received a deceased donor kidney (77.3%) and basiliximab induction therapy (86.4%). The overall CDI incidence was 3%. Factors independently associated with CDI were average tacrolimus trough ( AOR = 1.25, 95% CI = 1.00‐1.56, P = .048) and antibiotic exposure for urinary tract infections ( UTI ) ( AOR = 4.17, 95% CI = 1.12‐15.54, P = .034). Proton pump inhibitor use was not associated with CDI ( OR = 0.81, 95% CI = 0.29‐2.29, P = .691). Conclusion Maintaining a clinically appropriate tacrolimus trough and judicious antibiotic use and selection for UTI treatment could potentially reduce CDI in the kidney transplant population.