Clinical Risk Factors for the Recurrence of Clostridium difficile Infection (CDI) in Solid Organ Transplant Recipients (SOTR).

Y. Natori, M. Shiotsuka, L. Oen, E. Renner, L. Singer, J. Kim, H. Ross, D. Kumar, C. Rotstein, A. Humar, S. Husain.

Multi-Organ Transplant, University Health Network, Toronto, ON, Canada.

Meeting: 2016 American Transplant Congress

Abstract number: D114

Keywords: Bacterial infection, Outcome, Risk factors

Session Information

Session Name: Poster Session D: Fungi, PJP, Mycobacteria, Infection Risk Factors, Vaccination and Donor Derived Infections

Session Type: Poster Session

Date: Tuesday, June 14, 2016

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Introduction:

CDI is a common complication in SOTR. Recurrence may occur after treatment of the initial episode. However, the clinical risk factors of the recurrence of CDI in SOTR are not well defined.

Methods:

SOTR transplanted at our center with Clostridium difficile positive PCR(Cepheid Xpert) from January 2011 to December 2014 were identified from the Clinical Microbiology Laboratory database. Multivariable risk factors analysis was performed using logistic regression. The primary outcome was recurrent CDI within 8 weeks of treatment discontinuation.

Results:

200 SOTR were diagnosed with CDIs. The median age of the cohort was 56(range 20 to 81)years and transplant types were kidney (n=65), liver (n=71), lung (n=39), heart (n=14), kidney/pancreas (n=8), liver/kidney (n=2) and heart/lung (n=1). CDI occurred at a median of 235.5 days post-transplant. 81 patients received Metronidazole alone. The primary outcome occurred in 16 %(32/200) patients. Factors predictive of recurrence are shown below

	Non Recurrence N=168	Recurrence N=32	Univariate p value	OR(95% CI)	Multivariate p value	OR(95%CI)
Thoracic transplant	40(23.8%)	14(43.8%)	0.020	2.49(1.14-5.45)	0.153
Recent hospital stay	103(61.3%)	26(81.3%)	0.031	2.73(1.07-7.00)	0.211
Fluoroquinolones	54(32.3%)	16(50.0%)	0.055	2.09(0.97-4.50)	0.352
3^rd, 4^th generation Cephalosporins	33(19.6%)	12(37.5%)	0.027	2.46(1.09-5.52)	0.210
Pipercillin/ Tazobactam	62(36.9%)	19(61.3%)	0.011	2.71(1.23-5.95)	0.503
PPI	126(75%)	30(93.8%)	0.019	5.00(1.15-21.82)	0.026	7.36(1.26-43.00)
Severe CDI	86(51.2%)	12(37.5%)	0.156	0.57(0.26-1.24)	0.020	0.34(0.13-0.84)
Metronidazole alone	100(59.5%)	19(59.4%)	0.987

. Proton pomp inhibitor(PPI) usage was associated with higher rate of recurrence. Severity of CDI was associated with less rate of recurrence. The use of metronidazole alone in the treatment of CDI was not associated with recurrence. Recurrence was associated with longer duration of hospital stay [30.2(55.6) vs 55.9(61.4) days; p=0.03 ] and higher rate of readmission within 30 days[43(25.6%) vs. 19(59.4%) ;p<0.001].

Conclusions:

Our study showed that recurrent CDI occurred in 16% of SOTR. In our multivariate analysis, only PPI usage was a risk factor for recurrence. Also recurrence was associated with longer hospital stay and higher rate of readmission within 30 days.

CITATION INFORMATION: Natori Y, Shiotsuka M, Oen L, Renner E, Singer L, Kim J, Ross H, Kumar D, Rotstein C, Humar A, Husain S. Clinical Risk Factors for the Recurrence of Clostridium difficile Infection (CDI) in Solid Organ Transplant Recipients (SOTR). Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Natori Y, Shiotsuka M, Oen L, Renner E, Singer L, Kim J, Ross H, Kumar D, Rotstein C, Humar A, Husain S. Clinical Risk Factors for the Recurrence of Clostridium difficile Infection (CDI) in Solid Organ Transplant Recipients (SOTR). [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-risk-factors-for-the-recurrence-of-clostridium-difficile-infection-cdi-in-solid-organ-transplant-recipients-sotr/. Accessed May 21, 2025.

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