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. 2013 Apr;15(2):134-41.
doi: 10.1111/tid.12030. Epub 2012 Nov 23.

Epidemiology, risk factors, and outcomes of Clostridium difficile infection in kidney transplant recipients

D Neofytos  1 , K Kobayashi, C D Alonso, J Cady-Reh, D Lepley, M Harris, N Desai, E Kraus, A Subramanian, S Treadway, D Ostrander, C Thompson, K Marr
Affiliations

Epidemiology, risk factors, and outcomes of Clostridium difficile infection in kidney transplant recipients

D Neofytos et al. Transpl Infect Dis. 2013 Apr.

Abstract

Background: We sought to describe the epidemiology and risk factors for Clostridium difficile infection (CDI) among kidney transplant recipients (KTR) between 1 January 2008 and 31 December 2010.

Methods: A single-institution retrospective study was conducted among all adult KTR with CDI, defined as a positive test for C. difficile by a cell cytotoxic assay for C. difficile toxin A or B or polymerase chain reaction test for toxigenic C. difficile.

Results: Among 603 kidney transplants performed between 1 January 2008 and 31 December 2010, 37 (6.1%) patients developed CDI: 12 (of 128; 9.4%) high-risk (blood group incompatible and/or anti-human leukocyte antigen donor-specific antibodies) vs. 25 (of 475; 5.3%, P = 0.08) standard-risk patients. The overall rate of CDI increased from 3.7% in 2008 to 9.4% in 2010 (P = 0.05). The median time to CDI diagnosis was 9 days, with 27 (73.0%) patients developing CDI within the first 30 days after their transplant, and 14 (51.8%) developing CDI within 7 days. A case-control analysis of 37 CDI cases and 74 matched controls demonstrated the following predictors for CDI among KTR: vancomycin-resistant Enterococcus colonization before transplant (odds ratio [OR]: 3.6, P = 0.03), receipt of an organ from Centers for Disease Control high-risk donor (OR: 5.9, P = 0.006), and administration of high-risk antibiotics within 30 days post transplant (OR: 6.6, P = 0.001).

Conclusions: CDI remains a common early complication in KTR, with rates steadily increasing during the study period. Host and transplant-related factors and exposure to antibiotics appeared to significantly impact the risk for CDI among KTR.

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Conflict of interest statement

Conflicts of Interest: D.N. has received research grants from Pfizer. K.A.M. has received grant support from Astellas, Merck and Pfizer and have served on advisory boards/or as consultant for Astellas, Merck, Optimer, and Pfizer. All other authors: No conflicts of interest.

Figures

Fig. 1
Fig. 1
Rates of Clostridium difficile infection (CDI) -calculated by number of CDI cases/number of kidney transplant per year, among all (standard and high-risk) kidney transplant recipients between 1 January 2008 and 31 December 2010. P-values were calculated with the chi -square test for 1) all kidney (P=0.05), 2) standard risk kidney (P=0.002), and 3) high-risk kidney transplant recipients (P=0.4) with CDI between 2008 and 2010.
Fig. 2
Fig. 2
Time to diagnosis of Clostridium difficile infection (CDI) for all kidney transplant recipients between 1 January 2008 and 31 December 2010.
See this image and copyright information in PMC

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