An analysis of the outcomes of Clostridioides difficile occurring in intestinal transplant recipients requiring hospitalization

Abstract

Background: Organ transplantation is a known risk factor for Clostridioides difficile infection (CDI). There is limited published data on the impact of CDI in the intestinal transplant population. Methods:We utilized the National Readmission Database (2010Database ( -2017 to study the outcomes of CDI in patients having a history of intestinal transplantation. Association of CDI with readmission and hospital resource utilization was computed in multivariable models adjusted for demographics and comorbidities. Results: During 2010-2017, 8442 hospitalizations with the history of intestinal transplantation had indexed hospital admissions. Of these, 320 (3.8%) had CDI. CDI hospitalization in intestine transplant patients was associated with higher median cost $54 430 (IQR: 27 231, 109 980) as compared to patients who did not have CDI $48 888 (IQR: 22 578, 112 777), (β: 71 814 95% confidence intervals [CI]: 676-142 953, p = .048). The median length of stay was also longer for patients with CDI 7 (IQR: 4, 13) days as compared to 5 (IQR: 3, 11) days in non-CDI (β: 5.51 95% CI: 0.73-10.29, p = .02). The mortality rate, intestinal transplant complications, presence of malnutrition, acute kidney injury, ICU admissions, and sepsis were similar in both groups. CDI was the top cause of 30-day readmission in the intestinal transplant recipients with CDI during the index admission; the number of 30-day readmissions also increased from 2010 to 2017. Conclusion: CDI hospitalization in post-intestine transplant patients occurs commonly and is associated with a longer length of stay and higher costs during hospitalization. The CDI was the most common cause of readmission after the index admission of CDI in these patients.

Clostridioides difficile infection in intestinal transplantation: The quest for better outcomes continues

“…In this issue of Transplant Infectious Diseases, Amjad et al present a study on the burden of CDI in the intestinal transplant population and its impact on clinical outcomes and resource utilization. 7 Levering the nation's largest inpatient dataset of encounter-level hospital care and all-payer data (The National Readmission Database, 2010-2017), which provides ∼20% of the stratified sample of all hospitals in the United States, the authors analyzed 8442 index hospitalizations in ITRs, of which, 320 (3.8%) corresponded to CDIs. Only adult patients (>18-year age) were included in this study.…”