Outcomes of Clostridium difficile infection in recipients of solid abdominal organ transplants

• Published in: Clinical transplantation Vol. 28; no. 2; pp. 267 - 273
• Main Authors: Hsu, Jennifer L., Enser, James J., McKown, Trevor, Leverson, Glen E., Pirsch, John D., Hess, Timothy M., Safdar, Nasia
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.02.2014
• Subjects: abdominal organ transplant; Anti-Bacterial Agents - therapeutic use; Clostridium difficile; Clostridium difficile - isolation & purification; diarrhea; Diarrhea - drug therapy; Diarrhea - microbiology; Diarrhea - mortality; Enterocolitis, Pseudomembranous - drug therapy; Enterocolitis, Pseudomembranous - microbiology; Enterocolitis, Pseudomembranous - mortality; Female; Follow-Up Studies; Hospitalization; Humans; Kidney Transplantation; Length of Stay; Liver Transplantation; Male; Middle Aged; mortality; Prognosis; Retrospective Studies; transplantation; Vancomycin - therapeutic use; Wisconsin - epidemiology; Wisconsin; mortality; abdominal organ transplant; diarrhea; Clostridium difficile; transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12309

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.