Clostridium difficile infection in solid organ transplant recipients

Abstract

C. difficile is a significant pathogen in solid organ transplant recipients. Multiple risk factors are found in this population that may result in more severe disease. A high index of suspicion is necessary for the early diagnosis and treatment of C. difficile infection in transplant recipients. Metronidazole and vancomycin show equivalent efficacy in the treatment for mild-to-moderate disease, but vancomycin has demonstrated superiority in the treatment of severe disease. Surgical intervention is also an important consideration in the treatment of solid organ transplant recipients with severe colitis. Rigorous infection control practices are essential for preventing the spread of C. difficile within the hospital environment.

Solid organ recipients are at increased risk for recurrent Clostridium difficile colitis

“…Nevertheless, in transplant recipients with diarrhea, CDAC should always be very high in the suspected diagnoses. A recent report suggested that SOT recipients may not be at high risk for relapsing CDAC; however, others have found the opposite [1,3,10,11].…”

“…A growing number of reports have emphasized that solid organ transplant (SOT) recipients carry a high risk to develop Clostridium difficile-associated colitis (CDAC) [1][2][3][4][5][6][7][8][9][10][11]. Moreover, the course of the disease seems to be more severe in this patient population [1,4,6,10].…”

Abordaje multidisciplinario de la infección por Clostridium difficile

“…Aunque la administración antimicrobiana previa se ha demostrado en más de 95% de los pacientes inmunocompetentes con ICD, esta asociación se reduce a 80% en receptores de trasplante de órgano sólido. La reducción en la relación con exposición antimicrobiana puede ser secundaria a alteraciones en la microbiota normal y al deterioro de la inmunidad debido a inmunosupresores, enfermedad pre-trasplante grave e intervención quirúrgica 34,35 . La disfunción del sistema inmune es también un importan-te factor de riesgo en pacientes receptores de trasplante de órgano sólido.…”

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

“…Immunocompromised patients may represent a special subset of CDI for which the incidence and treatment may be more challenging to approach, in particular those with solid organ transplantation. The incidence of CDI in transplant patients has been estimated at 3%-7% for liver recipients, 3.5%-16% for kidney recipients, 1.5%-7.8% in pancreas-kidney recipients, 9% in intestinal recipients, 15% in heart recipients, and 7%-31% in lung recipients [16] . Further fulminant colitis is noted to occur in up to 8% of immunocompromised patients and 13% of solid organ transplant recipients with the highest incidence within the first 3 mo [17,18] .…”

“…In a prospective study of diarrheal pathogens, 20% of infections were community acquired. For an additional 15% of patients, CDI was acquired in the hospital, but diarrhea began after discharge at home for a total of 43% of cases with onset of symptoms at home [16] . As many as 25% of all cases of CDI develop in nursing home patients [1] .…”