Clostridium difficile infection, a descriptive analysis of solid organ transplant recipients at a single center

Tsapepas, Demetra; Martin, Spencer T.; Miao, Jennifer; Shah, Shreya; Scheffert, Jenna; Fester, K.A.; Ma, Karlene; Lat, Asma; Egan, Ron; McKeen, Jaclyn T.

doi:10.1016/j.diagmicrobio.2014.11.018

Cited by 20 publications

(18 citation statements)

References 17 publications

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“…(22) In a single center descriptive study, Tsapepas, et al found an overall incidence of 4% among SOTs, with the highest occurring in lung transplant recipients. (15) Our study differed from prior efforts in several important ways, potentially leading to differing results. For instance, we examined only hospital-onset infection occurring during the transplant stay.…”

Section: Discussionmentioning

confidence: 79%

“…(8, 15, 22) In a recent meta-analysis, Paudel, et al examined thirty studies assessing CDI among SOTs from 1991-2014, spanning three continents. (22) The authors reported a pooled CDI rate of 7.4%, with the highest burden in co-transplants and transplants of the lung, liver, and intestine.…”

Section: Discussionmentioning

confidence: 99%

“…(13, 14) Although several prior efforts have examined the epidemiology of CDI among SOT recipients, there are few data on hospital-onset CDI during the transplant hospitalization, as well as utilization of health services and institutional variation in CDI. (8, 14, 15)…”

Section: Introductionmentioning

confidence: 99%

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Hospital-Onset Clostridium difficile Infection Among Solid Organ Transplant Recipients

Donnelly

Wang

Locke

et al. 2015

American Journal of Transplantation

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Clostridium difficile infection (CDI) is a considerable health issue in the United States, and represents the most common healthcare-associated infection. Solid organ transplant recipients are at increased risk of CDI, which can impact graft as well as patient survival. However, little is known about the impact of CDI on health services utilization post-transplant. We examined hospital-onset CDI from 2012-2014 among transplant recipients in the University HealthSystem Consortium, which includes academic medical center-affiliated hospitals in the US. Infection was five times more common among transplant recipients compared to general inpatients (209 vs. 40 per 10,000 discharges) and factors associated with CDI among transplant recipients included transplant type, risk of mortality, comorbidities, and inpatient complications. Institutional risk-standardized CDI varied more than three-fold across high-volume hospitals (infection ratio 0.54-1.82; median 1.04; interquartile range 0.78-1.28). CDI was associated with increased 30-day readmission, transplant organ complications and cytomegalovirus infection, inpatient costs, and lengths of stay. Total observed inpatient days and direct costs for those with CDI were substantially higher than risk-standardized expected values (40,094 vs. 22,843 days; $198,728,368 vs. $154,020,528 costs). Further efforts to detect, prevent, and manage CDI among solid organ transplant recipients are warranted.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Hospital-Onset Clostridium difficile Infection Among Solid Organ Transplant Recipients

Donnelly

Wang

Locke

et al. 2015

American Journal of Transplantation

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“…Use of granulocyte stimulating factor did not appear to play a significant role between groups [47]. Other solid organ transplant recipients seem to follow a similar pattern; a descriptive analysis at a single center of patients with C. difficile infection involving recipients of Heart, Lung, Liver, Kidney and multi-organ, mean white blood cell counts in all the groups did not appear to be > 10,000 cells/mm 3 [48]. …”

Section: Leukocytes and Scoring Systemsmentioning

confidence: 99%

Role of the leukocyte response in normal and immunocompromised host after Clostridium difficile infection

2017

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Clostridium difficile is the leading cause of healthcare-associated infections in the United States. Clinically, C. difficile-associated disease can present as asymptomatic colonization, self-limited diarrheal illness or severe colitis (that may result in death). This variability in disease course and outcomes suggests that host factors play an important role as key determinants of disease severity. Currently, there are several scoring indices to estimate severity of C. difficile-associated disease. Leukocytosis and renal failure are considered to be the most important predictors of C. difficile disease severity in hosts with a normal immune system. The degree of leukocytosis which is considered significant for severe disease and how it is scored vary amongst scoring indices. None of the scores have been prospectively validated, and while total WBC count is useful to estimate the magnitude of the host response in most patient populations, in immune-compromised patients like those receiving chemotherapy, solid organ transplant patients or hematopoietic stem cell transplants the WBC response can be variable or even absent making this marker of severity difficult to interpret. Other cellular subsets like neutrophils, eosinophils and lymphocytes provide important information about the host immune status and play an important role in the immune response against C. difficile infection. However, under the current scoring systems the role of these cellular subsets have been underestimated and only total white blood cell counts are taken into account. In this review we highlight the role of host leukocyte response to C. difficile challenge in the normal and immunocompromised host, and propose possible ways that would allow for a better representation of the different immune cell subsets (neutrophils, lymphocytes and eosinophils) in the current scoring indices.

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“…Compared with the general population, SOT recipients with CDI are at increased risk for mortality, need for colectomy, intensive care unit (ICU) admission, length of stay, 30‐day readmission, recurrence of CDI, and healthcare costs . In addition, CDI in SOT recipients may indirectly contribute to other post‐transplant complications, including post‐transplant lymphoproliferative disorders, graft‐vs‐host disease, graft failure, and acute or chronic rejection …”

Section: Introductionmentioning

confidence: 99%

Clostridioides difficile infection and recurrence among 2622 solid organ transplant recipients

Schluger

Rosenblatt

Knotts

et al. 2019

Transplant Infectious Dis

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Background Clostridioides difficile infection (CDI) is common after solid organ transplant (SOT) and is associated with high morbidity and mortality. Methods We assessed incidence, risk factors, and outcomes of CDI among SOT patients at a large multi‐organ transplant center. Multivariable logistic regression was used to identify risk factors for initial and recurrent CDI. Results A total of 2622 SOT patients were included. 224 (8.5%) had CDI 1 year post‐SOT. The highest incidence of CDI was among pancreas recipients (12.5%) followed by lung (11.7%), liver (11.0%), heart (10.8%), and kidney (5.8%). Median time to CDI was 56 days (range 2‐354) post‐SOT. About 64% of patients had severe CDI. About 56.3% were treated with metronidazole, 13.8% with oral vancomycin, and 28.6% with both. About 28.6% of patients had recurrent CDI. In multivariable modeling, lung transplant recipient status was the only significant predictor of recurrent CDI (OR 4.97, 95% CI 2.11‐11.78, P < .001) controlling for age, severe CDI, and pre‐SOT CDI. Post‐SOT CDI nearly doubled the risk of mortality at one year, in particular among those with severe CDI. Conclusions In summary, CDI is highly prevalent, occurs early in the post‐transplant period, usually severe, with a high rate of recurrence, and associated with increased mortality within 1 year after transplant. The early post‐transplant period may be a crucial window to reduce CDI rates.

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Clostridium difficile infection, a descriptive analysis of solid organ transplant recipients at a single center

Cited by 20 publications

References 17 publications

Hospital-Onset Clostridium difficile Infection Among Solid Organ Transplant Recipients

Hospital-Onset Clostridium difficile Infection Among Solid Organ Transplant Recipients

Role of the leukocyte response in normal and immunocompromised host after Clostridium difficile infection

Clostridioides difficile infection and recurrence among 2622 solid organ transplant recipients

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