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. 2015 Nov;15(11):2970-7.
doi: 10.1111/ajt.13491.

Hospital-onset Clostridium difficile infection among solid organ transplant recipients

J P Donnelly  1   2   3 , H E Wang  1 , J E Locke  4 , R B Mannon  4   5   6 , M M Safford  2 , J W Baddley  4   7
Affiliations

Hospital-onset Clostridium difficile infection among solid organ transplant recipients

J P Donnelly et al. Am J Transplant. 2015 Nov.

Abstract

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 affect both graft and patient survival. However, little is known about the impact of CDI on health services utilization posttransplantation. We examined hospital-onset CDI from 2012 to 2014 among transplant recipients in the University HealthSystem Consortium, which includes academic medical center-affiliated hospitals in the United States. Infection was five times more common among transplant recipients than among general medicine 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 3-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, 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, costs $198 728 368 vs $154 020 528). Further efforts to detect, prevent, and manage CDI among solid organ transplant recipients are warranted.

Keywords: bacterial: clostridium difficile; complication: infectious; health services and outcomes research; infection and infectious agents; infectious disease.

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Conflict of interest statement

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Dr. Baddley reports consulting for Merck, Astellas and Pfizer. Dr. Safford reports investigator initiated research from Amgen. The other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Hospital-onset Clostridium difficile infection incidence by SOT type, 2012-2014. SOT = solid organ transplant. Error bars represent 95% confidence interval limits. Confidence intervals estimated using the binomial exact method.
Figure 2
Figure 2
Risk-standardized infection ratios for hospital-onset Clostridium difficile infection among transplant hospitals 2012-2014 N = 54 hospitals. Error bars represent 95% confidence intervals. Infection Ratio = 1 represents a hospital performing at the consortium average. Infection Ratio > 1 is worse than average. Infection Ratio < 1 better than average. Y-axis shown on logarithmic scale. Triangle markers represent hospitals significantly above or below the average consortium performance.
See this image and copyright information in PMC

References

    1. Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, et al. Burden of Clostridium difficile infection in the United States. The New England journal of medicine. 2015;372(9):825–834. - PMC - PubMed
    1. McDonald EG, Milligan J, Frenette C, Lee TC. Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent Clostridium difficile Infection. JAMA internal medicine. 2015;175(5):784–791. - PubMed
    1. Brown K, Valenta K, Fisman D, Simor A, Daneman N. Hospital Ward Antibiotic Prescribing and the Risks of Clostridium difficile Infection. JAMA internal medicine. 2015;175(4):626–633. - PubMed
    1. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care-associated infections. The New England journal of medicine. 2014;370(13):1198–1208. - PMC - PubMed
    1. Hall AJ, Curns AT, McDonald LC, Parashar UD, Lopman BA. The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2012;55(2):216–223. - PubMed

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