Outcomes of Clostridium Difficile Infection in Recipients of Solid Abdominal Organ Transplants

Overview

Journal Clin Transplant

Specialty General Surgery

Date 2014 Jan 31

PMID 24476412

Citations 6

Authors

Jennifer L Hsu

James J Enser

Trevor McKown

Glen E Leverson

John D Pirsch

Timothy M Hess

Nasia Safdar

Affiliations

Soon will be listed here.

Abstract

Knowledge of outcomes of Clostridium difficile infection (CDI) in solid organ transplant (SOT) recipients is limited. To evaluate this population, we undertook a retrospective cohort study of all recipients of kidney and liver transplants diagnosed with CDI at a single center over 14 yr. Data pertaining to all episodes of CDI were collected. Multivariate analysis using logistic regression was performed to determine independent predictors of clinical cure. Overall, 170 patients developed 215 episodes of CDI. Among these patients, 162 episodes (75%) were cured, and in 103 episodes (48%), patients were cured within 14 d. In a multivariate analysis, lack of clinical cure at 14 d was predicted by recurrent episode (0.21, 95% CI 0.06-0.72, p = 0.0128), treatment with vancomycin (OR 0.27, 95% CI 0.1-0.74, p = 0.011), vasopressor support (OR 0.23, 95% CI 0.07-0.76, p = 0.0161), and CDI before the year 2004 (OR 0.44, 95% CI 0.2-0.98, p = 0.0446). The latter three factors are likely markers for severity of illness. In this cohort, 13 patients (8%) died during hospitalization, and 49 patients (29%) died within one yr. No deaths were attributed to CDI. Recurrent episode was a major predictor of treatment failure, suggesting that research into development of therapeutic options for recurrent disease is needed.

Citing Articles

The Interplay between Gut Microbiota and the Immune System in Liver Transplant Recipients and Its Role in Infections.

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PMID: 34460287 PMC: 8519297. DOI: 10.1128/IAI.00376-21.

Repeated Clostridium difficile infection after living donor liver transplantation.

Abe K, Shiba H, Furukawa K, Sakamoto T, Ishida Y, Yanaga K Clin J Gastroenterol. 2018; 11(4):309-311.

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Clostridium difficile Infection in Special High-Risk Populations.

Cozar-Llisto A, Ramos-Martinez A, Cobo J Infect Dis Ther. 2016; 5(3):253-69.

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Sepsis in the severely immunocompromised patient.

Kalil A, Opal S Curr Infect Dis Rep. 2015; 17(6):487.

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Prevalence of Clostridium difficile infection among solid organ transplant recipients: a meta-analysis of published studies.

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References

West M, Pirenne J, Chavers B, Gillingham K, Sutherland D, Dunn D . Clostridium difficile colitis after kidney and kidney-pancreas transplantation. Clin Transplant. 1999; 13(4):318-23. DOI: 10.1034/j.1399-0012.1999.130407.x. View

Albright J, Bonatti H, Mendez J, Kramer D, Stauffer J, Hinder R . Early and late onset Clostridium difficile-associated colitis following liver transplantation. Transpl Int. 2007; 20(10):856-66. DOI: 10.1111/j.1432-2277.2007.00530.x. View

Clutter D, Dubrovskaya Y, Merl M, Teperman L, Press R, Safdar A . Fidaxomicin versus conventional antimicrobial therapy in 59 recipients of solid organ and hematopoietic stem cell transplantation with Clostridium difficile-associated diarrhea. Antimicrob Agents Chemother. 2013; 57(9):4501-5. PMC: 3754298. DOI: 10.1128/AAC.01120-13. View

Loo V, Poirier L, Miller M, Oughton M, Libman M, Michaud S . A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005; 353(23):2442-9. DOI: 10.1056/NEJMoa051639. View

Riddle D, Dubberke E . Clostridium difficile infection in solid organ transplant recipients. Curr Opin Organ Transplant. 2008; 13(6):592-600. DOI: 10.1097/MOT.0b013e3283186b51. View

Herrero J, Benlloch S, Bernardos A, Bilbao I, Castells L, Castroagudin J . Gastrointestinal complications in liver transplant recipients: MITOS study. Transplant Proc. 2007; 39(7):2311-3. DOI: 10.1016/j.transproceed.2007.06.012. View

Dubberke E, Riddle D . Clostridium difficile in solid organ transplant recipients. Am J Transplant. 2010; 9 Suppl 4:S35-40. PMC: 3899697. DOI: 10.1111/j.1600-6143.2009.02891.x. View

Dudukgian H, Sie E, Gonzalez-Ruiz C, Etzioni D, Kaiser A . C. difficile colitis--predictors of fatal outcome. J Gastrointest Surg. 2009; 14(2):315-22. DOI: 10.1007/s11605-009-1093-2. View

Zar F, Bakkanagari S, Moorthi K, Davis M . A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007; 45(3):302-7. DOI: 10.1086/519265. View

10.

Johnson S . Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect. 2009; 58(6):403-10. DOI: 10.1016/j.jinf.2009.03.010. View

11.

Stelzmueller I, Goegele H, Biebl M, Wiesmayr S, Berger N, Tabarelli W . Clostridium difficile colitis in solid organ transplantation--a single-center experience. Dig Dis Sci. 2007; 52(11):3231-6. DOI: 10.1007/s10620-007-9770-z. View

12.

Dallal R, Harbrecht B, Boujoukas A, Sirio C, Farkas L, Lee K . Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg. 2002; 235(3):363-72. PMC: 1422442. DOI: 10.1097/00000658-200203000-00008. View

13.

Mitu-Pretorian O, Forgacs B, Qumruddin A, Tavakoli A, Augustine T, Pararajasingam R . Outcomes of patients who develop symptomatic Clostridium difficile infection after solid organ transplantation. Transplant Proc. 2010; 42(7):2631-3. DOI: 10.1016/j.transproceed.2010.04.057. View

14.

Gil-Vernet S, Amado A, Ortega F, Alarcon A, Bernal G, Capdevila L . Gastrointestinal complications in renal transplant recipients: MITOS study. Transplant Proc. 2007; 39(7):2190-3. DOI: 10.1016/j.transproceed.2007.07.015. View

15.

Gellad Z, Alexander B, Liu J, Griffith B, Meyer A, Johnson J . Severity of Clostridium difficile-associated diarrhea in solid organ transplant patients. Transpl Infect Dis. 2007; 9(4):276-80. DOI: 10.1111/j.1399-3062.2007.00255.x. View

16.

Niemczyk M, Leszczyniski P, Wyzgal J, Paczek L, Krawczyk M, Luczak M . Infections caused by clostridium difficile in kidney or liver graft recipients. Ann Transplant. 2005; 10(2):70-4. View

17.

Wong N, Bathgate A, Bellamy C . Colorectal disease in liver allograft recipients -- a clinicopathological study with follow-up. Eur J Gastroenterol Hepatol. 2002; 14(3):231-6. DOI: 10.1097/00042737-200203000-00005. View

18.

Pant C, Anderson M, OConnor J, Marshall C, Deshpande A, Sferra T . Association of Clostridium difficile infection with outcomes of hospitalized solid organ transplant recipients: results from the 2009 Nationwide Inpatient Sample database. Transpl Infect Dis. 2012; 14(5):540-7. DOI: 10.1111/j.1399-3062.2012.00761.x. View

19.

Boutros M, Al-Shaibi M, Chan G, Cantarovich M, Rahme E, Paraskevas S . Clostridium difficile colitis: increasing incidence, risk factors, and outcomes in solid organ transplant recipients. Transplantation. 2012; 93(10):1051-7. DOI: 10.1097/TP.0b013e31824d34de. View

20.

Len O, Rodriguez-Pardo D, Gavalda J, Aguado J, Blanes M, Borrell N . Outcome of Clostridium difficile-associated disease in solid organ transplant recipients: a prospective and multicentre cohort study. Transpl Int. 2012; 25(12):1275-81. DOI: 10.1111/j.1432-2277.2012.01568.x. View