Incidence and Risks Associated With Clostridium Difficile Infection in the Pediatric Solid Organ Transplantation Population: A Single-Center Retrospective Review
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH
2Xavier University, Cincinnati, OH.
Meeting: 2015 American Transplant Congress
Abstract number: B26
Keywords: Bacterial infection, Pediatric, Risk factors
Session Information
Session Name: Poster Session B: Bacterial/Fungal/Other Infections
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Morbidity and mortality related to Clostridium difficile Infection (CDI) has increased. Adult SOT data have reported risk factors for CDI. We interrogated the epidemiology of CDI to delineate the incidence and risk factors for CDI within an exclusive pediatric SOT cohort.
We performed a retrospective cohort study of all pediatric SOT ≤ 18 years of age at transplant from 1/2010 until 12/2013 (n=202). Demographics, antibiotic usage (cumulative (#days) and intensity (#days on 3+ antibiotic)), transplant details and other potential risk factors were captured from the EHR (EPIC, Madison, WI) and infection surveillance software (VigiLanz, Minneapolis, MN). CDI episode data was collected and compared with matched CDI-negative controls.
The majority was male (117, 58%) and Caucasian (156, 77%). Kidney transplant (85, 42%) was most common followed by liver (76, 38%), heart (34, 17%), and multivisceral/intestine (7, 3%). Age at transplant ranged from 3 weeks to 18 years with a median of 4.7 years and mean of 6.6 years (IQR 1.5 – 11.2 years).
Of the 202 patients, 104 symptomatic SOT had at least one test for CDI. 25 patients were positive at least once. Most testing occurred by 60 days post-transplant (mean 170 days, median 48 days, IQR 3-327days). First negative tests occurred earlier (mean 127 days, median 28 days, IQR 10-108 days) compared to the 25 patients with first positive tests (mean 243 days, median 109 days IQR 33-379 days). In univariable analyses, age, sex, ethnicity, obesity, and CNI choice were not associated with CDI. Liver recipients were more likely to have CDI compared to kidney/heart recipients (18.4% liver, 4.7% kidney, 8.8% heart p<0.01).
20 CDI subjects were matched to controls. Neither recent hospitalization nor antibiotic use or intensity (within 90, 30 or 14 days) was associated with CDI. Acid-blockade was protective (RR 0.13, 95% CI 0.02-0.78).
Pediatric liver recipients were at increased risk of CDI. Unlike adult studies, antibiotic use and hospitalization were not associated with increased CDI risk and acid-blockade was protective. Additional evaluation of CDI risk in pediatric SOT is necessary with these noted differences from adult data.
| Positive CDI Test | Negative CDI Test | Not Tested | |
| Heart | 3 | 9 | 22 |
| Kidney | 4 | 23 | 58 |
| Liver | 14 | 44 | 18 |
| Intestine/Multivisceral | 4 | 3 | 0 |
To cite this abstract in AMA style:
Danziger-Isakov L, Ciricillo J, Blum S, Kim M-O, Liu C, Paulsen G, Courter J, Haslam D. Incidence and Risks Associated With Clostridium Difficile Infection in the Pediatric Solid Organ Transplantation Population: A Single-Center Retrospective Review [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/incidence-and-risks-associated-with-clostridium-difficile-infection-in-the-pediatric-solid-organ-transplantation-population-a-single-center-retrospective-review/. Accessed May 17, 2025.« Back to 2015 American Transplant Congress