Clostridium difficile Infection (CDI) has been shown to occur at a higher rate in the solid organ transplant (SOT) population compared to the general hospitalized population, and incidence has increased in recent years. Immunosuppression, including antibody induction, may contribute to the development of CDI.

Methods: We retrospectively determined the incidence, treatment, and recurrence of CDI within the first year after transplant for patients (kidney, liver, lung, heart, pancreas) transplanted from 2005 to 2012. We assessed potential risk factors for CDI including length of stay, pre-infection antibiotics, proton-pump inhibitors (PPI), and induction. CDI cases were identified by confirmation with laboratory testing. Incidence of recurrence (re-appearance of CDI within 2 months), and reinfection (re-appearance of CDI in greater than 2 months) was collected.

Results: Of 872 patients, 31 had confirmed CDI. The incidence was 1.7% kidney, 5% liver, 2.4% heart, and 2.5% lung. In cases 38%, and 19% received basiliximab or alemtuzumab respectively. 93.5% were on a PPI, 87% received treatment dose antibiotics within 3 months of CDI. Metronidazole was the most common first line agent. Treatment failure requiring change to alternative agent occurred in 52%. Recurrence and reinfection occurred in 16% and 6% of cases respectively. No infections resulted in graft loss or patient death, 16% demonstrated signs of colitis but did not require colectomy.

Conclusions: CDI within SOT was found to be most common in liver transplants. CDI onset frequently occurs within the first few months after transplant. About 50% of patients require another course of therapy with an alternative agent suggesting vancomycin may be a better option as first line in these patients. Many known risk factors are present in these patients, but induction does not appear to be associated with CDI.

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