Epidemiology and outcomes of Clostridium difficile infection in allogeneic hematopoietic cell and lung transplant recipients

E. R. Dubberke, K. A. Reske, M. A. Olsen, K. Bommarito, A. A. Cleveland, F. P. Silveira, M. G. Schuster, C. A. Kauffman, Robin Avery, P. G. Pappas, T. M. Chiller

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Abstract

Background: Clostridium difficile infection (CDI) is a common complication of lung and allogeneic hematopoietic cell (HCT) transplant, but the epidemiology and outcomes of CDI after transplant are poorly described. Methods: We performed a prospective, multicenter study of CDI within 365 days post-allogeneic HCT or lung transplantation. Data were collected via patient interviews and medical chart review. Participants were followed weekly in the 12 weeks post-transplant and while hospitalized and contacted monthly up to 18 months post-transplantation. Results: Six sites participated in the study with 614 total participants; 4 enrolled allogeneic HCT (385 participants) and 5 enrolled lung transplant recipients (229 participants). One hundred and fifty CDI cases occurred within 1 year of transplantation; the incidence among lung transplant recipients was 13.1% and among allogeneic HCTs was 31.2%. Median time to CDI was significantly shorter among allogeneic HCT than lung transplant recipients (27 days vs 90 days; P =.037). CDI was associated with significantly higher mortality from 31 to 180 days post-index date among the allogeneic HCT recipients (Hazard ratio [HR] = 1.80; P =.007). There was a trend towards increased mortality among lung transplant recipients from 120 to 180 days post-index date (HR = 4.7, P =.09). Conclusions: The epidemiology and outcomes of CDI vary by transplant population; surveillance for CDI should continue beyond the immediate post-transplant period.

Original languageEnglish (US)
Article numbere12855
JournalTransplant Infectious Disease
Volume20
Issue number2
DOIs
StatePublished - Apr 1 2018

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Keywords

  • Clostridium difficile
  • epidemiology
  • hematopoetic cell transplant
  • lung transplant
  • outcomes

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

Dubberke, E. R., Reske, K. A., Olsen, M. A., Bommarito, K., Cleveland, A. A., Silveira, F. P., Schuster, M. G., Kauffman, C. A., Avery, R., Pappas, P. G., & Chiller, T. M. (2018). Epidemiology and outcomes of Clostridium difficile infection in allogeneic hematopoietic cell and lung transplant recipients. Transplant Infectious Disease, 20(2), [e12855]. https://doi.org/10.1111/tid.12855