Clostridioides difficile infection and recurrence among 2622 solid organ transplant recipients

Abstract

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.

Effectiveness of Bezlotoxumab for Prevention of Recurrent Clostridioides difficile Infection Among Transplant Recipients

“…We determined that a sample size of 118 patients per group would be required to achieve a statistical power of 80% to detect a 50% relative difference in rCDI at 90 days using an α = .05. We projected an event rate of 30% in the SoC cohort based on previously published literature and an event rate of 15% in the BEZ cohort using data from controlled clinical trials and limited retrospective data [ 6 , 11–15 ].…”

“…Fulminant CDI, for example, is estimated at 15% in SOT recipients, 2-fold higher than the general population [ 4 , 5 ]. The sequelae of rCDI are more severe among transplant populations as infections within 1 year posttransplantation are associated with graft loss and a significant increase in mortality [ 2 , 6–8 ]. Additionally, risk of recurrence increases with each successive episode, whereby SOT and HCT patients are at incrementally higher risk for adverse outcomes with each CDI event [ 9 ].…”

How to Apply FMT More Effectively, Conveniently and Flexible – A Comparison of FMT Methods

“…Depending on several factors (ribotype, age, health condition), the mortality varies between 4-7% (Kwon et al, 2015). Metronidazole and vancomycin are still in the guidelines, but neither offers a satisfying level of effectiveness (Schluger et al, 2019). Fidaxomicin is a successful antibiotic with respect to both effectiveness and recurrence rate (Madoff et al, 2019).…”

Experience With Moxifloxacin for the Treatment of Latent Tuberculosis Infection in Liver Transplantation: A Single‐Center Prospective Study

“…The rate of CDI observed (13.2%) was of concern but consistent with previous LT cohorts. (7,8) Our study has some limitations. Although recruitment was performed during a 4-year period, the number of patients was relatively small, which could have prevented the detection of rare, potentially severe, AEs.…”