Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection in Solid Organ Transplant Recipients at an Academic Medical Center
Center for Transplantation, University of California, San Diego Health System, La Jolla, CA
Meeting: 2019 American Transplant Congress
Abstract number: 232
Keywords: Bacterial infection, Immunosuppression, Infection, Monoclonal antibodies
Session Information
Session Name: Concurrent Session: Infectious Epidemiology
Session Type: Concurrent Session
Date: Monday, June 3, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: Room 304
*Purpose: In the United States, the incidence of Clostridium difficile infection (CDI) has increased remarkably and remains a significant burden in the solid organ transplant (SOT) population. In comparison to the general population, SOT recipients with CDI have worse outcomes, including increased hospital length of stay and fulminant colitis. Recurrent CDI (rCDI) rates are estimated to be as high as 30% in SOT population. Known risk factors for rCDI include age ≥ 65 years, immunocompromise, history of CDI, severe CDI, and 027/078/244 strain. The primary objective is to describe the impact of bezlotoxumab on 90-day CDI recurrence in the SOT population at a single academic center. We further provide a description of rCDI risk factors, incidence of acute kidney injury (AKI), severe CDI, and 90-day mortality.
*Methods: This is a retrospective chart review of adult SOT recipients with CDI diagnosed between June 30, 2017 and September 30, 2018. Patients received standard-of-care antibiotics with or without bezlotoxumab per physician discretion.
*Results: A total of 21 patients received treatment for CDI during the study period; n = 12 in the bezlotoxumab group, n = 9 in the control group. As noted in Table 1, baseline characteristics were similar. 90-day recurrence rates in patients that received bezlotoxumab was 9% (n = 1 of 11*) numerically lower than the control group recurrence rate of 33% (n = 3 of 9), however there was no statistical difference (p = 0.368). There were no deaths within 90 days of CDI.
| Bezlotoxumab n = 12 | No Bezlotoxumab n = 9 | |
| Age in years, (median) | 54 | 62 |
| Male, n (%) | 7 (58) | 5 (55) |
| Days post transplant at time of CDI diagnosis median, (IQ range) | 182 (119-611) | 1334 (116-4049) |
| < 1 year post transplant, n (%) | 8 (67) | 4 (44) |
| Type of transplant (n, %) | ||
| Kidney | 4 (33) | 1 (11) |
| Liver | 3 (25) | 4 (44) |
| Heart | 2 (17) | 0 |
| Lung | 2 (12) | 3 (33) |
| Combined | 1 (8) | 1 (11) |
| Lymphocyte depleting antibody, n (%) | 6 (50) | 1 (11) |
| Treatment for rejection 3 months prior, n (%) | 3 (25) | 0 |
| Antibiotic use within 3 months, n (%) | 11 (92) | 7 (78) |
| Age ≥ 65yo | 2 (17) | 3 (33) |
| CDI Treatment n (%) | ||
| Oral Vancomycin | 9 (75) | 6 (67) |
| Oral metronidazole | 0 | 1 (11) |
| IV metronidazole | 1 (8) | 0 |
| IV Tigecycline | 1 (8) | 0 |
| Fecal Microbiota Transplant | 2 (22) | 2 (22) |
| History of previous CDI within 6 months, n(%) | 6 (50) | 2 (22) |
| # risk factors | ||
| 1 | 4 (33) | 3 (33) |
| 2 | 6 (50) | 5( 56) |
| ≥3 | 2 (17) | 1 (11) |
| AKI defined as serum creatinine > 1.5 x baseline | 2 (17) | 1 (11) |
| Severe CDI, n(%) | 2 (17) | 3 (33) |
| 90-Day Mortality, n (%) | 0 | 0 |
| 90-Day recurrence | 1 (9)* | 3 (33) |
| *one patient 90-day recurrence TBD |
*Conclusions: In our single-center study of 21 SOT recipients with CDI, 90-day CDI recurrence rate was lower in the group that received bezlotoxumab, though not statistically significant (probably related to low sample size). There was no difference in incidence of AKI, severe CDI, or death. Pre-specified risk factors were similar between both groups. A larger study comparing patients with similar risk factors is needed to provide data on impact of bezlotoxumab on rCDI rates, morbidity and mortality.
To cite this abstract in AMA style:
Kerr JS, Law N, Aslam S. Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection in Solid Organ Transplant Recipients at an Academic Medical Center [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/bezlotoxumab-for-prevention-of-recurrent-clostridium-difficile-infection-in-solid-organ-transplant-recipients-at-an-academic-medical-center/. Accessed November 22, 2024.« Back to 2019 American Transplant Congress