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Multicenter Study
. 2024 Dec;89(6):106306.
doi: 10.1016/j.jinf.2024.106306. Epub 2024 Oct 5.

Recurrent Clostridioides difficile infections in solid organ transplant recipients: The international CALIPSO study

Giusy Tiseo  1 , Dafna Yahav  2 , Alaa Atamna  3 , Tomer Avni  3 , Manuel Causse  4 , Elena Pérez-Nadales  4 , Alessandra Mularoni  5 , Elena Reigadas  6 , María Olmedo-Samperio  6 , Mario Fernández-Ruiz  6 , Zaira R Palacios-Baena  7 , Jesus Rodríguez-Baño  7 , Paolo De Simone  8 , Giandomenico Biancofiore  9 , Eman Fares Sabik  10 , Mical Paul  10 , José María Aguado  6 , Ugo Boggi  11 , Patricia Muñoz  6 , Julián Torres-Cisneros  4 , Alessio Farcomeni  12 , Marco Falcone  13 ; ESCMID Study Group for Infections in the Elderly (ESGIE)
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Free article
Multicenter Study

Recurrent Clostridioides difficile infections in solid organ transplant recipients: The international CALIPSO study

Giusy Tiseo et al. J Infect. 2024 Dec.
Free article

Abstract

Objective: To evaluate the risk of recurrent Clostridioides difficile infection (CDI) in solid-organ transplant (SOT) recipients.

Methods: Retrospective multicenter study including SOT recipients with a first CDI episode in the year after transplantation (Jan 2017-June 2020). The primary outcome measure was recurrence, defined as a new CDI ≤56 days from the first episode. A competing risk analysis was performed using the sub-distribution hazard model multivariable analysis.

Results: 191 SOT recipients were included: 101 (52.9%) were kidney, 66 (34.6%) liver, 11 (5.8%) lung, 8 (4.2%) simultaneous pancreas-kidney, 4 (2.1%) heart and 1 (0.5%) pancreas alone recipients. Treatment for the first CDI were: vancomycin (n = 114,59.7%), vancomycin+metronidazole (n = 39,20.4%), metronidazole (n = 26,13.6%), fidaxomicin (n = 9,4.7%), 3 patients did not receive any therapy. After the first CDI, 17/191 (8.9%) patients died within 56-day mortality without having a recurrence, while 23/191 (12%) patients had a recurrence. Among patients with recurrent CDI, 56-day mortality rate was 30.4% (7/23 patients). On multivariable analysis, severe CDI (sHR4.01, 95% CI 1.77-9.08, p < .001) and metronidazole monotherapy (sHR 3.65, 95% CI 1.64-8.14, p = .001) were factors independently associated with recurrence.

Conclusions: Metronidazole monotherapy is associated with increased risk of recurrent CDI in SOT recipients. Therapeutic strategies aimed to reduce the risk of recurrence should be implemented in this setting.

Keywords: Bezlotoxumab; Clostridioides difficile; Metronidazole; Recurrence; Solid organ transplant.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: GT received honoraria for educational meetings by Shionogi and participated to scientific board for MSD. MF received unconditional grants from MSD, Gilead and speaker honoraria from Shionogi, Pfizer, Menarini, MSD, Gilead, GSK, MundiPharma and TermoFisher. Declared conflicts of interest are outside the submitted work and did not affect the scientific objectivity of this study. The other authors have none to declare.

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