Clostridium difficile infection (CDI) is one of the most common hospital-acquired infections among the general inpatient population with recurrence rates of 20-30% despite appropriate treatment. Solid organ transplant recipients have a higher incidence of CDI due to their immunosuppressed state. This study aimed to determine if the antibiotic chosen for initial CDI treatment impacts recurrence rates in transplant recipients. In this retrospective analysis of 2281 adult abdominal organ transplant recipients, 163 (7.1%) had an initial CDI within one year of transplant. Twenty patients (15.9%) had recurrent CDI within 6 months of the initial CDI. There was no difference in the primary outcome of CDI recurrence in transplant recipients who received metronidazole or oral vancomycin (17.4% vs. 11.8%, p=0.5865) for treatment of the initial CDI. When CDI was assessed by transplanted organ, 22.6% of kidney transplant recipients receiving metronidazole versus 20% receiving oral vancomycin had CDI recurrence. CDI recurrence was found in 6.9% of liver transplant recipients receiving metronidazole versus in 5% receiving oral vancomycin. Initial CDI occurred within the first six months of transplant in 87% of patients. Recurrent CDI was experienced in 90% of patients within three months of the initial CDI. Based on this cohort of abdominal organ transplant recipients, the antibiotic selected for initial CDI treatment did not influence CDI recurrence rates, and antibiotic treatment selection should not differ from the general population.

CITATION INFORMATION: Moorman A., Todd S., Lyon III G., Triemer H. Clostridium difficile Recurrence in Abdominal Organ Transplant Recipients: Metronidazole versus Oral Vancomycin Am J Transplant. 2017;17 (suppl 3).

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