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

D. Neofytos, 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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)134-141
Number of pages8
JournalTransplant Infectious Disease
Volume15
Issue number2
DOIs
StatePublished - Apr 1 2013

Keywords

  • Clostridium difficile
  • Kidney transplant

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

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