Purpose: Solid organ transplant (SOT) recipients are at risk for Clostridium difficile infection (CDI) due to immunosuppression, frequent healthcare system contact, and liberal use of broad-spectrum anti-infectives and acid suppressants. Given that incidence is expected to vary by organ, we sought to quantify organ-specific rates of CDI and associated mortality in the first post-transplant year.

Methods: An IRB-approved review of adult SOT recipients from 1/2012-1/2013 was conducted to determine 12-month CDI incidence and associated mortality; pertinent demographics and readmission data was collected for the first post-transplant year. All CDI was diagnosed by PCR.

Results: A total of 338 SOT recipients were included; 25 (7.4%) developed CDI within the first post-transplant year. 164 kidney, 93 liver, 46 heart, and 35 lung transplant recipients were included; 12-month incidence of CDI by organ was 3% (5/164), 9.7% (9/93), 10.8% (5/46), and 14.3% (5/35) respectively. CDI was not associated with a statistically significant increase in 1-year mortality (12% vs. 5.75%, p=0.2); mortality was also no different within each organ group (figure 1). Non-renal transplant was associated with significantly higher rates of CDI (11.5% vs. 3%, p=0.003). No baseline demographics appeared to contribute to increased risk of CDI development, save initial transplant length of stay, which was significantly longer for CDI patients compared with non-CDI (12 days vs. 7 days, p=0.018).

Conclusions: CDI is a prevalent nosocomial infection post-transplant, especially in the non-renal transplant population. Prolonged length of stay appears to increase CDI risk. Despite a lack of statistical significance, there was an alarmingly increased rate of mortality in those with CDIs.

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